1003889346 NPI number — ENDOSCOPY GROUP LLC

Table of content: (NPI 1003889346)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003889346 NPI number — ENDOSCOPY GROUP LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ENDOSCOPY GROUP LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003889346
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/01/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4810 N DAVIS HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PENSACOLA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32503-2341
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-477-8109
Provider Business Mailing Address Fax Number:
850-478-9903

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4810 N DAVIS HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PENSACOLA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32503-2341
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-474-8988
Provider Business Practice Location Address Fax Number:
850-478-9903
Provider Enumeration Date:
02/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DUNN
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR/CFO
Authorized Official Telephone Number:
850-474-8988

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 490003997 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5121097 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3804534 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 987585 . This is a "USA HEALTH NETWORK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 079204700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 65B . This is a "HEALTH OPTIONS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 079204700 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com