Provider Demographics
NPI:1518034354
Name:NORTH COAST ENDOSCOPY, LLC
Entity Type:Organization
Organization Name:NORTH COAST ENDOSCOPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:AIMEE
Authorized Official - Middle Name:CATHLEEN
Authorized Official - Last Name:JUDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-737-4665
Mailing Address - Street 1:65 GERMANTOWN CT STE 300
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-4258
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:901-328-1355
Practice Address - Street 1:9500 MENTOR AVE
Practice Address - Street 2:SUITE 380
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060
Practice Address - Country:US
Practice Address - Phone:440-352-9400
Practice Address - Fax:440-352-9407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH143 FACILITY# 0084AS261QE0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0901500Medicaid
6800024OtherUNITED HEALTHCARE
18966OtherQUALCHOICE
000000157346OtherANTHEM
314359OtherUPMC
104697OtherKAISER
490002140OtherRAILROAD MEDICARE
=========005OtherMEDICAL MUTUAL
490002140OtherRAILROAD MEDICARE