Provider Demographics
NPI:1437122637
Name:TAMARAC ENDOSCOPY ASC LLC
Entity Type:Organization
Organization Name:TAMARAC ENDOSCOPY ASC LLC
Other - Org Name:DIGESTIVE DISEASE ENDOSCOPY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:BILLIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:PAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-665-1283
Mailing Address - Street 1:7481 N UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-2971
Mailing Address - Country:US
Mailing Address - Phone:954-718-1000
Mailing Address - Fax:954-718-1012
Practice Address - Street 1:7481 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-2971
Practice Address - Country:US
Practice Address - Phone:954-718-1000
Practice Address - Fax:954-718-1012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-08
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1109261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL070778300Medicaid
FL=========OtherHUMANA MILITARY HEALTHCAR
FL070778300Medicaid
FL10-C0001338Medicare Oscar/Certification
FL=========OtherHUMANA MILITARY HEALTHCAR