Provider Demographics
NPI:1083946149
Name:METHODIST ENDOSCOPY CENTER LLC
Entity Type:Organization
Organization Name:METHODIST ENDOSCOPY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:TYRON
Authorized Official - Middle Name:A
Authorized Official - Last Name:ALLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-397-7057
Mailing Address - Street 1:515 NORTH 162 AVENUE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68118-2540
Mailing Address - Country:US
Mailing Address - Phone:402-505-8708
Mailing Address - Fax:402-505-8748
Practice Address - Street 1:515 NORTH 162 AVENUE
Practice Address - Street 2:SUITE 201
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68118-2540
Practice Address - Country:US
Practice Address - Phone:402-505-8708
Practice Address - Fax:402-505-8748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-01
Last Update Date:2010-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEPENDING261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical