Provider Demographics
NPI:1164818191
Name:WICHITA FALLS ENDOSCOPY CENTER, LP
Entity Type:Organization
Organization Name:WICHITA FALLS ENDOSCOPY CENTER, LP
Other - Org Name:WICHITA FALLS ENDOSCOPY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMIISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:BESHEAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-761-9034
Mailing Address - Street 1:1500 9TH ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76301-4323
Mailing Address - Country:US
Mailing Address - Phone:940-761-9034
Mailing Address - Fax:940-761-7510
Practice Address - Street 1:1500 9TH ST
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-4323
Practice Address - Country:US
Practice Address - Phone:940-761-9034
Practice Address - Fax:940-761-7510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-07
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8194261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
671506500407Medicare Oscar/Certification
TXASC259Medicare PIN