1679529630 NPI number — THE NEW ORLEANS LA ENDOSCOPY ASC LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679529630 NPI number — THE NEW ORLEANS LA ENDOSCOPY ASC LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE NEW ORLEANS LA 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:
THE ENDOSCOPY CENTER OF NEW ORLEANS
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:
1679529630
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
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:
37215-6154
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-665-1283
Provider Business Mailing Address Fax Number:
615-234-1820

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2701 NAPOLEON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW ORLEANS
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70115-6913
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-899-1121
Provider Business Practice Location Address Fax Number:
504-899-1170
Provider Enumeration Date:
05/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCDONALD
Authorized Official First Name:
KEN
Authorized Official Middle Name:
P
Authorized Official Title or Position:
CHIEF MANAGER OF LLC
Authorized Official Telephone Number:
615-665-1283

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  134 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1621714 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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