Provider Demographics
NPI: | 1033126222 |
---|---|
Name: | ENDOSCOPY CENTER OF COLUMBUS, LLC |
Entity Type: | Organization |
Organization Name: | ENDOSCOPY CENTER OF COLUMBUS, LLC |
Other - Org Name: | ENDOSCOPY CENTER OF COLUMBUS, INC |
Other - Org Type: | Former Legal Business Name |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | |
Authorized Official - First Name: | PRAVINCHANDRA |
Authorized Official - Middle Name: | H |
Authorized Official - Last Name: | PATEL |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 706-327-0700 |
Mailing Address - Street 1: | 1130 TALBOTTON RD |
Mailing Address - Street 2: | |
Mailing Address - City: | COLUMBUS |
Mailing Address - State: | GA |
Mailing Address - Zip Code: | 31904-8749 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 706-641-6900 |
Mailing Address - Fax: | 706-327-0757 |
Practice Address - Street 1: | 1130 TALBOTTON RD |
Practice Address - Street 2: | |
Practice Address - City: | COLUMBUS |
Practice Address - State: | GA |
Practice Address - Zip Code: | 31904-8745 |
Practice Address - Country: | US |
Practice Address - Phone: | 706-641-6900 |
Practice Address - Fax: | 706-327-0757 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-08-01 |
Last Update Date: | 2008-12-02 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QE0800X | Ambulatory Health Care Facilities | Clinic/Center | Endoscopy |