Provider Demographics
NPI:1417957796
Name:ENDOSCOPY CENTER OF MONROE
Entity Type:Organization
Organization Name:ENDOSCOPY CENTER OF MONROE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:WALDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-327-3105
Mailing Address - Street 1:316 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-7568
Mailing Address - Country:US
Mailing Address - Phone:318-327-3107
Mailing Address - Fax:318-327-3110
Practice Address - Street 1:316 S 6TH ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-7568
Practice Address - Country:US
Practice Address - Phone:318-327-3107
Practice Address - Fax:318-327-3110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-28
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA38261QE0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy
Provider Identifiers
StateIdentifier IDID TypeIssuer
P2590OtherRAILROAD MEDICARE
2059COtherBLUE CROSS OF LOUISIANA
LA1385735Medicaid
LA1385735Medicaid