Provider Demographics
NPI:1609953942
Name:ENDOSCOPY CENTER OF OCALA INC
Entity Type:Organization
Organization Name:ENDOSCOPY CENTER OF OCALA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:EMERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-671-3882
Mailing Address - Street 1:1901 SE 18TH AVE
Mailing Address - Street 2:BUILDING #400
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-8215
Mailing Address - Country:US
Mailing Address - Phone:352-732-8905
Mailing Address - Fax:352-732-2307
Practice Address - Street 1:1901 SE 18TH AVE
Practice Address - Street 2:BUILDING #400
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-8215
Practice Address - Country:US
Practice Address - Phone:352-732-8905
Practice Address - Fax:352-732-2440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3751791-00Medicaid
FL39464Medicare PIN
FL3751791-00Medicaid