Provider Demographics
NPI:1033392154
Name:GREENBELT ENDOSCOPY CENTER
Entity Type:Organization
Organization Name:GREENBELT ENDOSCOPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BETANCES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-552-1801
Mailing Address - Street 1:9821 GREENBELT RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-2265
Mailing Address - Country:US
Mailing Address - Phone:301-552-1801
Mailing Address - Fax:301-552-2695
Practice Address - Street 1:9821 GREENBELT RD
Practice Address - Street 2:SUITE 103
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-2265
Practice Address - Country:US
Practice Address - Phone:301-552-1801
Practice Address - Fax:301-552-2695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-12
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA1212261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDFDG001Medicare PIN