Provider Demographics
NPI:1528032711
Name:COLUMBIA ENDOSCOPY CENTER, LLC
Entity Type:Organization
Organization Name:COLUMBIA ENDOSCOPY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:LLORENS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:573-449-3500
Mailing Address - Street 1:208 PORTLAND ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-6525
Mailing Address - Country:US
Mailing Address - Phone:573-449-3500
Mailing Address - Fax:573-449-5097
Practice Address - Street 1:208 PORTLAND ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-6525
Practice Address - Country:US
Practice Address - Phone:573-449-3500
Practice Address - Fax:573-449-5097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-14
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO143-1261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO509395208Medicaid
MO000040069Medicare PIN