| Organization Name: | GI WELLNESS CENTER OF FREDERICK, LLC |
| NPI Number: | 1013372986 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SCOTT EDWARD ANDOCHICK (OWNER) |
| Mailing Address: | 165 Thomas Johnson Dr Suite B&c Frederick |
| State: | MD US |
| Postal Code: | 217024742 |
| Phone Number: | 3016204200 |
| Fax Number: | |
| NPI Enumeration Date: | 12/21/2015 |
| NPI Last Update Date: | 12/21/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QE0800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MD |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Endoscopy |
| Taxonomy Definition: | |