Basic Information
| Provider Information | |||||||||
| NPI: | 1932276276 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CANTON GENERAL SURGERY ASSOCIATES, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2600 TUSCARAWAS ST WEST | ||||||||
| Address2: | SUITE 420 | ||||||||
| City: | CANTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3304534300 | ||||||||
| FaxNumber: | 3304533617 | ||||||||
| Practice Location | |||||||||
| Address1: | 2600 TUSCARAWAS ST W | ||||||||
| Address2: | SUITE 420 | ||||||||
| City: | CANTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 447084644 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3304534300 | ||||||||
| FaxNumber: | 3304533617 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2006 | ||||||||
| LastUpdateDate: | 10/18/2007 | ||||||||
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| AuthorizedOfficialLastName: | CAMARATA | ||||||||
| AuthorizedOfficialFirstName: | JULIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 3304534300 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 0298628 | 05 | OH | MEDICAID | 2345966 | 05 | OH | MEDICAID | 0668648 | 05 | OH | MEDICAID |