Provider Demographics
NPI:1689910739
Name:THE ENDOSCOPY CENTER AT BAINBRIDGE, LLC
Entity Type:Organization
Organization Name:THE ENDOSCOPY CENTER AT BAINBRIDGE, LLC
Other - Org Name:UNIVERSITY SUBURBAN ENDOSCOPY CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:P
Authorized Official - Last Name:SABLYAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-589-9001
Mailing Address - Street 1:1611 S GREEN RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44121-4129
Mailing Address - Country:US
Mailing Address - Phone:440-708-0582
Mailing Address - Fax:440-708-0583
Practice Address - Street 1:1611 S GREEN RD
Practice Address - Street 2:
Practice Address - City:SOUTH EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44121-4129
Practice Address - Country:US
Practice Address - Phone:440-708-0582
Practice Address - Fax:440-708-0583
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE ENDOSCOPY CENTER AT BAINBRIDGE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-12-18
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical