Provider Demographics
NPI:1710081443
Name:VENTURA ENDOSCOPY CENTER LLC
Entity Type:Organization
Organization Name:VENTURA ENDOSCOPY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR/CMS AUTHORIZED OFF
Authorized Official - Prefix:
Authorized Official - First Name:TESU
Authorized Official - Middle Name:N
Authorized Official - Last Name:LIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-641-6525
Mailing Address - Street 1:5810 RALSTON STREET
Mailing Address - Street 2:SUITE 101
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-6010
Mailing Address - Country:US
Mailing Address - Phone:805-650-5500
Mailing Address - Fax:805-650-5505
Practice Address - Street 1:5810 RALSTON STREET
Practice Address - Street 2:SUITE 101
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003
Practice Address - Country:US
Practice Address - Phone:805-650-5500
Practice Address - Fax:805-650-5505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50000592261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
S051656Medicare PIN