Portage Regional Gastroenterology, LLC

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

Legal business name

PORTAGE REGIONAL GASTROENTEROLOGY, LLC

Practice address

330 N Chestnut St
Ravenna, OH 44266-2287

Phone

(330) 296-7256

Fax

(330) 296-0127

NPI assigned

Oct 18, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Michael S Cline, DO

Title

Owner

Phone

(330) 296-7256

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1192665600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1192665600000",
    "number": "1235328980",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "330 N CHESTNUT ST",
            "city": "RAVENNA",
            "state": "OH",
            "postal_code": "442662287",
            "telephone_number": "330-296-7256",
            "fax_number": "330-296-0127"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 N CHESTNUT ST",
            "city": "RAVENNA",
            "state": "OH",
            "postal_code": "442662287",
            "telephone_number": "330-296-7256",
            "fax_number": "330-296-0127"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORTAGE REGIONAL GASTROENTEROLOGY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-18",
        "last_updated": "2007-10-18",
        "status": "A",
        "authorized_official_last_name": "CLINE",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "330-296-7256",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0131593",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Gastroenterology Physician in Ravenna, OH
• Providers in Ravenna, OH by specialty
• Gastroenterology Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.