1073939682 NPI number — CENTER FOR ENDOSCOPY LLC

Table of content: DOUGLAS VAUN PLESHAW JR. (NPI 1649413154)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073939682 NPI number — CENTER FOR ENDOSCOPY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTER FOR ENDOSCOPY 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:
1073939682
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
401 COMMERCE ST
Provider Second Line Business Mailing Address:
STE 600
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37219-2446
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-345-6879
Provider Business Mailing Address Fax Number:
615-345-6879

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3921 WARING RD
Provider Second Line Business Practice Location Address:
STE B
Provider Business Practice Location Address City Name:
OCEANSIDE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92056-4456
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-345-6879
Provider Business Practice Location Address Fax Number:
615-345-6879
Provider Enumeration Date:
03/07/2014

Additional Information

Authorized Official

Authorized Official Last Name:
HOLST
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
W.
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
615-345-6899

Provider Taxonomy Codes

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

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





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