1578561890 NPI number — THE ENDOSCOPY CENTER AT ST. FRANCIS, LLC

Table of content: (NPI 1578561890)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578561890 NPI number — THE ENDOSCOPY CENTER AT ST. FRANCIS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE ENDOSCOPY CENTER AT ST. FRANCIS, 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:
1578561890
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/02/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8051 S EMERSON AVE
Provider Second Line Business Mailing Address:
SUITE 150
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46237-8600
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-865-2955
Provider Business Mailing Address Fax Number:
317-865-2952

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8051 S EMERSON AVE
Provider Second Line Business Practice Location Address:
STE 150
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46237-8635
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-865-2955
Provider Business Practice Location Address Fax Number:
317-865-2952
Provider Enumeration Date:
07/11/2005

Additional Information

Authorized Official

Authorized Official Last Name:
DRAKE
Authorized Official First Name:
LUCAS
Authorized Official Middle Name:
M
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
317-865-2955

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QE0800X , with the licence number: 05-008858-1 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 200064740A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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