Provider Demographics
NPI:1407247208
Name:COLONOSCOPY AND ENDOSCOPY CENTER LLC
Entity Type:Organization
Organization Name:COLONOSCOPY AND ENDOSCOPY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:SPRENKEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-313-0081
Mailing Address - Street 1:7211 N MAIN ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45415-2566
Mailing Address - Country:US
Mailing Address - Phone:937-350-6703
Mailing Address - Fax:
Practice Address - Street 1:7211 N MAIN ST
Practice Address - Street 2:SUITE 3
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45415-2566
Practice Address - Country:US
Practice Address - Phone:937-350-6703
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-15
Last Update Date:2015-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical