Provider Demographics
NPI:1346208642
Name:BRAWLEY ENDOSCOPY & SURGERY MED CTR
Entity Type:Organization
Organization Name:BRAWLEY ENDOSCOPY & SURGERY MED CTR
Other - Org Name:VALLEY ENDOSCOPY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MAHOMED
Authorized Official - Middle Name:
Authorized Official - Last Name:SULIMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-352-3000
Mailing Address - Street 1:PO BOX 2601
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92244-2601
Mailing Address - Country:US
Mailing Address - Phone:760-352-3000
Mailing Address - Fax:760-352-1985
Practice Address - Street 1:1550 N IMPERIAL AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-6304
Practice Address - Country:US
Practice Address - Phone:760-352-3000
Practice Address - Fax:760-352-1985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA090000507261QE0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA090000507OtherSTATE LICENSE
CASUR01326FMedicaid
CASUR01326FMedicaid