Provider Demographics
NPI:1578561890
Name:THE ENDOSCOPY CENTER AT ST. FRANCIS, LLC
Entity Type:Organization
Organization Name:THE ENDOSCOPY CENTER AT ST. FRANCIS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LUCAS
Authorized Official - Middle Name:M
Authorized Official - Last Name:DRAKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-865-2955
Mailing Address - Street 1:8051 S EMERSON AVE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-8600
Mailing Address - Country:US
Mailing Address - Phone:317-865-2955
Mailing Address - Fax:317-865-2952
Practice Address - Street 1:8051 S EMERSON AVE
Practice Address - Street 2:STE 150
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-8635
Practice Address - Country:US
Practice Address - Phone:317-865-2955
Practice Address - Fax:317-865-2952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-11
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QA1903X
IN05-008858-1261QE0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200064740AMedicaid
ZJ0600Medicare PIN