1992941462 NPI number — NORTHWEST ENDOSCOPY CENTER, 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 1992941462 NPI number — NORTHWEST ENDOSCOPY CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHWEST ENDOSCOPY CENTER, 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:
NORTH WEST 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:
1992941462
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/24/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
550 PEACHTREE ST NE
Provider Second Line Business Mailing Address:
SUITE 1600
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30308-2247
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-888-7575
Provider Business Mailing Address Fax Number:
404-885-7777

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
488 KENNESAW AVE NW
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
MARIETTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30060-9409
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-427-3075
Provider Business Practice Location Address Fax Number:
770-427-3261
Provider Enumeration Date:
01/05/2009

Additional Information

Authorized Official

Authorized Official Last Name:
BAKER
Authorized Official First Name:
JANA
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
404-888-7575

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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