Provider Demographics
NPI:1609841261
Name:WEST PALM BEACH FL ENDOSCOPY ASC LLC
Entity Type:Organization
Organization Name:WEST PALM BEACH FL ENDOSCOPY ASC LLC
Other - Org Name:CENTER FOR GASTROINTESTINAL ENDOSCOPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OF LLC
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:A
Authorized Official - Last Name:CLENDENIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-665-1283
Mailing Address - Street 1:1117 N OLIVE AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-3520
Mailing Address - Country:US
Mailing Address - Phone:561-514-0353
Mailing Address - Fax:561-514-0236
Practice Address - Street 1:1117 N OLIVE AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-3520
Practice Address - Country:US
Practice Address - Phone:561-514-0353
Practice Address - Fax:561-514-0236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-17
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1119261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00289060OtherRAILROAD MEDICARE
FL076072200Medicaid
FL=========OtherPGBA- TRICARE
FLP00289060OtherRAILROAD MEDICARE