Provider Demographics
NPI:1639159916
Name:GI ENDOSCOPY CENTER, INC
Entity Type:Organization
Organization Name:GI ENDOSCOPY CENTER, INC
Other - Org Name:GI ENDOSCOPY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:D
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-957-7734
Mailing Address - Street 1:2560 NW MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-5510
Mailing Address - Country:US
Mailing Address - Phone:541-673-2046
Mailing Address - Fax:541-673-0454
Practice Address - Street 1:2560 NW MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-5510
Practice Address - Country:US
Practice Address - Phone:541-673-2046
Practice Address - Fax:541-673-0454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR071432261QE0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR007034Medicaid
ORR0000DBBBVMedicare UPIN