Provider Demographics
NPI:1346213634
Name:SARASOTA ENDOSCOPY ASC LLC
Entity Type:Organization
Organization Name:SARASOTA ENDOSCOPY ASC LLC
Other - Org Name:BAYVIEW ENDOSCOPY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:A
Authorized Official - Last Name:CLENDENIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-665-1283
Mailing Address - Street 1:2800 BAHIA VISTA ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-2742
Mailing Address - Country:US
Mailing Address - Phone:941-373-9808
Mailing Address - Fax:941-373-9818
Practice Address - Street 1:2800 BAHIA VISTA ST
Practice Address - Street 2:SUITE 300
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2742
Practice Address - Country:US
Practice Address - Phone:941-373-9808
Practice Address - Fax:941-373-9818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-08
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1112261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL070806200Medicaid
FL070806200Medicaid
FL070806200Medicaid
FL490004858Medicare PIN
FL10-C0001339Medicare Oscar/Certification