Provider Demographics
NPI:1154318293
Name:ENDOSCOPY CENTER INC
Entity Type:Organization
Organization Name:ENDOSCOPY CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:K
Authorized Official - Last Name:KOFFEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-843-7993
Mailing Address - Street 1:3439 GRANITE CIR
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43617-1161
Mailing Address - Country:US
Mailing Address - Phone:419-843-7993
Mailing Address - Fax:419-841-7789
Practice Address - Street 1:3439 GRANITE CIR
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43617-1161
Practice Address - Country:US
Practice Address - Phone:419-843-7993
Practice Address - Fax:419-841-7789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-04
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0323546Medicaid
OH3610581Medicare PIN