Provider Demographics
NPI:1629262811
Name:PREMIER ENDOSCOPY CENTER LLC
Entity Type:Organization
Organization Name:PREMIER ENDOSCOPY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:MECKSTROTH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-287-9481
Mailing Address - Street 1:1656 MEDICAL BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110-1423
Mailing Address - Country:US
Mailing Address - Phone:239-593-6201
Mailing Address - Fax:239-593-6203
Practice Address - Street 1:1656 MEDICAL BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-1423
Practice Address - Country:US
Practice Address - Phone:239-593-6201
Practice Address - Fax:239-593-6203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-30
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1283261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical