Provider Demographics
NPI:1578810768
Name:COLONOSCOPYASSIST
Entity Type:Organization
Organization Name:COLONOSCOPYASSIST
Other - Org Name:ADVANCED HEALTHCARE CONSULTANTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:POONAWALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:855-542-6566
Mailing Address - Street 1:2100 VALLEY VIEW LN # 490
Mailing Address - Street 2:
Mailing Address - City:FARMERS BRANCH
Mailing Address - State:TX
Mailing Address - Zip Code:75234-8953
Mailing Address - Country:US
Mailing Address - Phone:855-542-6566
Mailing Address - Fax:847-847-2888
Practice Address - Street 1:2100 VALLEY VIEW LN # 490
Practice Address - Street 2:
Practice Address - City:FARMERS BRANCH
Practice Address - State:TX
Practice Address - Zip Code:75234-8953
Practice Address - Country:US
Practice Address - Phone:855-542-6566
Practice Address - Fax:847-847-2888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-07
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14D2042466291U00000X
IL019.0284991223G0001X
IL14D2042466291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes291U00000XLaboratoriesClinical Medical LaboratoryGroup - Single Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty