1316179963 NPI number — SHENANDOAH TX ENDOSCOPY ASC LLC

Table of content: (NPI 1316179963)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316179963 NPI number — SHENANDOAH TX ENDOSCOPY ASC LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHENANDOAH TX ENDOSCOPY ASC 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:
WOODLANDS ENDOSCOPY CENTER
Provider Other Organization Name Type Code:
3
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:
1316179963
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20 BURTON HILLS BLVD
Provider Second Line Business Mailing Address:
SUITE 500
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37215-6197
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-240-3720
Provider Business Mailing Address Fax Number:
615-234-1720

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 VISION PARK BLVD
Provider Second Line Business Practice Location Address:
SUITE 160
Provider Business Practice Location Address City Name:
SHENANDOAH
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77384-3002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
936-321-8910
Provider Business Practice Location Address Fax Number:
936-321-8913
Provider Enumeration Date:
08/17/2009

Additional Information

Authorized Official

Authorized Official Last Name:
CLENDENIN
Authorized Official First Name:
PHILLIP
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
615-665-1283

Provider Taxonomy Codes

  • Taxonomy code: 367500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 8L22271 . This is a "CRNA SANDRA LENHART" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8F33700 . This is a "CRNA JULIA MARTIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8L25451 . This is a "CRNA GLYNN COOPER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8L26184 . This is a "CRNA JAMES BODOH" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8L21238 . This is a "CRNA ROTH OWEN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8L22350 . This is a "CRNA JAMES MATTINGLY" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8F33699 . This is a "CRNA ESTHER SCOGGIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8F33701 . This is a "CRNA DUANE RIEGEL" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8F33698 . This is a "CRNA DANA FISHER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8L22270 . This is a "CRNA BRENDA MCCALL" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com