Provider Demographics
NPI:1558651059
Name:THE AC ENDOSCOPY GROUP PA
Entity Type:Organization
Organization Name:THE AC ENDOSCOPY GROUP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CLAYTON
Authorized Official - Middle Name:
Authorized Official - Last Name:FRENZEL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:210-573-7869
Mailing Address - Street 1:2215 CEDAR SPRINGS RD
Mailing Address - Street 2:APT 309
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201
Mailing Address - Country:US
Mailing Address - Phone:210-573-7869
Mailing Address - Fax:469-364-3756
Practice Address - Street 1:2215 CEDAR SPRINGS RD
Practice Address - Street 2:APT 309
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75201
Practice Address - Country:US
Practice Address - Phone:210-573-7869
Practice Address - Fax:469-364-3756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-18
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX045212208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty