Provider Demographics
NPI:1003067844
Name:ENDOCENTER LLC
Entity Type:Organization
Organization Name:ENDOCENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HAZEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAUEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-871-1721
Mailing Address - Street 1:58515 PEARL ACRES RD
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461-5423
Mailing Address - Country:US
Mailing Address - Phone:985-645-9392
Mailing Address - Fax:
Practice Address - Street 1:58515 PEARL ACRES RD
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-5423
Practice Address - Country:US
Practice Address - Phone:985-645-9392
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-09
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA120261QE0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy