Basic Information
| Provider Information | |||||||||
| NPI: | 1013319144 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DOCTORS HOSPITAL PHYSICIAN SERVICES LLC | ||||||||
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| OtherOrganizationName: | AFFINITY GASTROENTEROLOGY SERVICES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3722 DRESSLER RD NW | ||||||||
| Address2: | SUITE B | ||||||||
| City: | CANTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 447182700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3304799000 | ||||||||
| FaxNumber: | 3304775805 | ||||||||
| Practice Location | |||||||||
| Address1: | 3722 DRESSLER RD NW | ||||||||
| Address2: | SUITE B | ||||||||
| City: | CANTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 447182700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3304799000 | ||||||||
| FaxNumber: | 3304775805 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/19/2014 | ||||||||
| LastUpdateDate: | 09/29/2014 | ||||||||
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| AuthorizedOfficialLastName: | WRIGHT | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | PATRICK | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 6154657587 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QE0800X | Y | Ambulatory Health Care Facilities | Clinic/Center | Endoscopy |
No ID Information.