Provider Demographics
NPI:1083611990
Name:ASSOCIATED ENDOSCOPY LLC
Entity Type:Organization
Organization Name:ASSOCIATED ENDOSCOPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAROL
Authorized Official - Middle Name:A
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:615-885-1093
Mailing Address - Street 1:5651 FRIST BLVD
Mailing Address - Street 2:SUITE 307
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-2054
Mailing Address - Country:US
Mailing Address - Phone:615-885-1093
Mailing Address - Fax:615-885-1110
Practice Address - Street 1:5651 FRIST BLVD
Practice Address - Street 2:SUITE 307
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-2054
Practice Address - Country:US
Practice Address - Phone:615-885-1093
Practice Address - Fax:615-885-1110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000092261QE0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN6840076OtherUNITED HEALTHCARE ID#
TN3288038Medicaid
TN3108448OtherBLUE CROSS ID#
TN=========OtherTAX IDENTIFICATION#
TN3288038Medicaid