Provider Demographics
NPI:1659384329
Name:ENDOSCOPY CENTER LLC
Entity Type:Organization
Organization Name:ENDOSCOPY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LYNNE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARINI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-303-4200
Mailing Address - Street 1:1139 LEXINGTON AVE STE B
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31404
Mailing Address - Country:US
Mailing Address - Phone:912-303-4200
Mailing Address - Fax:912-790-2701
Practice Address - Street 1:1139 LEXINGTON AVE STE B
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404
Practice Address - Country:US
Practice Address - Phone:912-303-4200
Practice Address - Fax:912-790-2701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA02406261QE0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA976125519AMedicaid
GA976125519AMedicaid