Provider Demographics
NPI:1407065444
Name:ALBANY ENDOSCOPY CENTER, INC.
Entity Type:Organization
Organization Name:ALBANY ENDOSCOPY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LUCILE
Authorized Official - Middle Name:G
Authorized Official - Last Name:LOTT
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:229-438-8685
Mailing Address - Street 1:1009 N MONROE ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31701-1970
Mailing Address - Country:US
Mailing Address - Phone:229-438-8685
Mailing Address - Fax:
Practice Address - Street 1:1009 N MONROE ST
Practice Address - Street 2:SUITE 101
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-1970
Practice Address - Country:US
Practice Address - Phone:229-438-8685
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA047189261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA111165ASCAMedicare ID - Type Unspecified