Provider Demographics
NPI:1740201607
Name:TALLAHASSEE ENDOSCOPY CENTER INC
Entity Type:Organization
Organization Name:TALLAHASSEE ENDOSCOPY CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:L
Authorized Official - Last Name:MADANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-205-8404
Mailing Address - Street 1:2400 MICCOSUKEE RD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-5314
Mailing Address - Country:US
Mailing Address - Phone:850-205-8404
Mailing Address - Fax:850-216-1321
Practice Address - Street 1:2400 MICCOSUKEE RD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5314
Practice Address - Country:US
Practice Address - Phone:850-205-8404
Practice Address - Fax:850-216-1321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL749261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL61EOtherBCBS PROVIDER NUMBER
FL07069900OtherFLORIDA MEDICAID NUMBER
FL490001580OtherRRMCR PROVIDER NUMBER
FL07069900OtherFLORIDA MEDICAID NUMBER