Provider Demographics
NPI:1083000715
Name:CLEBURNE ENDOSCOPY CENTER, LLC
Entity Type:Organization
Organization Name:CLEBURNE ENDOSCOPY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:RINA
Authorized Official - Middle Name:
Authorized Official - Last Name:OSTRINSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:817-895-0095
Mailing Address - Street 1:1701 WALTER HOLIDAY DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76033-1187
Mailing Address - Country:US
Mailing Address - Phone:817-895-0095
Mailing Address - Fax:817-641-3355
Practice Address - Street 1:1701 WALTER HOLIDAY DR
Practice Address - Street 2:SUITE 100
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76033-1187
Practice Address - Country:US
Practice Address - Phone:817-895-0095
Practice Address - Fax:817-641-3355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-09
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
553403Medicare PIN