Provider Demographics
NPI:1427212919
Name:NORTH BAY ENDOSCOPY CENTER LLC
Entity Type:Organization
Organization Name:NORTH BAY ENDOSCOPY CENTER LLC
Other - Org Name:THE ENDOSURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:DENIGRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:707-938-9685
Mailing Address - Street 1:1383 N MCDOWELL BLVD
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954-1187
Mailing Address - Country:US
Mailing Address - Phone:707-938-9685
Mailing Address - Fax:707-938-9641
Practice Address - Street 1:1383 N MCDOWELL BLVD
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954-1187
Practice Address - Country:US
Practice Address - Phone:707-938-9685
Practice Address - Fax:707-938-9641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-14
Last Update Date:2009-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical