Provider Demographics
NPI:1346288032
Name:ENDOSCOPY CENTER AT RIDGE PLAZA LP
Entity Type:Organization
Organization Name:ENDOSCOPY CENTER AT RIDGE PLAZA LP
Other - Org Name:ENDOSCOPY CENTER AT MEDPOINT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:GUERRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-687-2673
Mailing Address - Street 1:1200 E SAVANNAH AVE
Mailing Address - Street 2:SUITE 15
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503-1728
Mailing Address - Country:US
Mailing Address - Phone:956-687-2673
Mailing Address - Fax:956-631-1091
Practice Address - Street 1:1200 E SAVANNAH AVE
Practice Address - Street 2:SUITE 15
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-1727
Practice Address - Country:US
Practice Address - Phone:956-687-2673
Practice Address - Fax:956-631-1091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00056761OtherRAILROAD MEDICARE
TX163422201Medicaid
TXHH070AOtherBLUE CROSS BLUE SHIELD
TX163422201Medicaid