Provider Demographics
NPI:1003889346
Name:ENDOSCOPY GROUP LLC
Entity Type:Organization
Organization Name:ENDOSCOPY GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-474-8988
Mailing Address - Street 1:4810 N DAVIS HWY
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2341
Mailing Address - Country:US
Mailing Address - Phone:850-477-8109
Mailing Address - Fax:850-478-9903
Practice Address - Street 1:4810 N DAVIS HWY
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2341
Practice Address - Country:US
Practice Address - Phone:850-474-8988
Practice Address - Fax:850-478-9903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-08
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
490003997OtherRAILROAD MEDICARE
5121097OtherAETNA
3804534OtherCIGNA
987585OtherUSA HEALTH NETWORK
FL079204700Medicaid
65BOtherHEALTH OPTIONS
490003997OtherRAILROAD MEDICARE
490003997OtherRAILROAD MEDICARE