Provider Demographics
NPI:1750312435
Name:CENTRAL ARIZONA ENDOSCOPY LLC
Entity Type:Organization
Organization Name:CENTRAL ARIZONA ENDOSCOPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:HOHLFELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-589-9024
Mailing Address - Street 1:2500 YORK RD STE 300
Mailing Address - Street 2:
Mailing Address - City:JAMISON
Mailing Address - State:PA
Mailing Address - Zip Code:18929-1098
Mailing Address - Country:US
Mailing Address - Phone:215-589-9024
Mailing Address - Fax:215-589-9039
Practice Address - Street 1:2158 N GILBERT RD
Practice Address - Street 2:BUILDING 1 SUITE 103
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85203-2112
Practice Address - Country:US
Practice Address - Phone:480-751-3002
Practice Address - Fax:480-751-3003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOSC 4093261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
03D1057109OtherCLIA WAIVER
AZOSC 4093OtherARIZONA LICENSE
AZ217237Medicaid
74203OtherAAAHC
74203OtherAAAHC