NPIMap

Organization Active NPI

Colon, Rectal and Laser Surgery Associates, Inc.

  • Colon & Rectal Surgery Physician
  • Maumee, OH
National Provider Identifier
1396959136
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Colon & Rectal Surgery PhysicianTaxonomy code 208C00000X
Legal business name
COLON, RECTAL AND LASER SURGERY ASSOCIATES, INC.
Practice address
5705 Monclova Rd
Suite 203
Maumee, OH 43537-1875
Phone
(419) 893-2622
Fax
(419) 893-2755
NPI assigned
May 10, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Raju S Shah, M.D.
Title
President
Phone
(419) 893-2622

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Colon & Rectal Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208C00000X Primary

Addresses

Primary practice location

5705 Monclova Rd
Suite 203
Maumee, OH 43537-1875

Mailing address

5705 Monclova Rd
Suite 203
Maumee, OH 43537-1875
Phone (419) 893-2622

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1178755200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1396959136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5705 MONCLOVA RD",
            "address_2": "SUITE 203",
            "city": "MAUMEE",
            "state": "OH",
            "postal_code": "435371875",
            "telephone_number": "419-893-2622",
            "fax_number": "419-893-2755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5705 MONCLOVA RD",
            "address_2": "SUITE 203",
            "city": "MAUMEE",
            "state": "OH",
            "postal_code": "435371875",
            "telephone_number": "419-893-2622",
            "fax_number": "419-893-2755"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLON, RECTAL AND LASER SURGERY ASSOCIATES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-10",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SHAH",
        "authorized_official_first_name": "RAJU",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "419-893-2622",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208C00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Colon & Rectal Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Maumee, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.