Provider Demographics
NPI:1346497989
Name:GRANT SCOPE CENTER, LLC
Entity Type:Organization
Organization Name:GRANT SCOPE CENTER, LLC
Other - Org Name:DOWNTOWN ENDOSCOPY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BOARD PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:614-458-1183
Mailing Address - Street 1:700 E BROAD ST
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-3946
Mailing Address - Country:US
Mailing Address - Phone:614-917-1670
Mailing Address - Fax:614-947-3991
Practice Address - Street 1:700 E BROAD ST
Practice Address - Street 2:1ST FLOOR
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-3946
Practice Address - Country:US
Practice Address - Phone:614-917-1670
Practice Address - Fax:614-947-3991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-26
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0928AS261QA1903X, 261QE0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3004233Medicaid
OH3612511Medicare PIN