Provider Demographics
NPI:1326142878
Name:LEBANON ENDOSCOPY CENTER LLC
Entity Type:Organization
Organization Name:LEBANON ENDOSCOPY CENTER LLC
Other - Org Name:LEBANON ENDOSCOPY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:L
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-763-3859
Mailing Address - Street 1:100 PHYSICIANS WAY
Mailing Address - Street 2:SUITE 340
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37090-8103
Mailing Address - Country:US
Mailing Address - Phone:615-446-9532
Mailing Address - Fax:615-466-9536
Practice Address - Street 1:100 PHYSICIANS WAY
Practice Address - Street 2:SUITE 340
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37090-8103
Practice Address - Country:US
Practice Address - Phone:615-446-9532
Practice Address - Fax:615-466-9536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QA1903X
TNPENDING261QE0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1518492Medicaid
TNP00649646OtherRAILROAD MEDICARE
TNP00649646OtherRAILROAD MEDICARE
TN3287010Medicare PIN