Provider Demographics
NPI:1205195716
Name:ADVANCED ENDOSCOPY AND PAIN CENTER LLC
Entity Type:Organization
Organization Name:ADVANCED ENDOSCOPY AND PAIN CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, BOARD OF MANAGERS
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:6153-456-6900
Mailing Address - Street 1:1753 W AVENUE J
Mailing Address - Street 2:STE A
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-9823
Mailing Address - Country:US
Mailing Address - Phone:661-206-0555
Mailing Address - Fax:
Practice Address - Street 1:1753 W AVENUE J
Practice Address - Street 2:STE A
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-9823
Practice Address - Country:US
Practice Address - Phone:661-206-0555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-04
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical