Provider Demographics
NPI:1821106907
Name:ENDOSCOPY ASSOCIATES LLC
Entity Type:Organization
Organization Name:ENDOSCOPY ASSOCIATES LLC
Other - Org Name:ENDOSCOPY ASSOCIATES CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF MANAGER OF LLC
Authorized Official - Prefix:MRS
Authorized Official - First Name:BILIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-665-1283
Mailing Address - Street 1:7401 OSLER DR
Mailing Address - Street 2:SUITE 108
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-7673
Mailing Address - Country:US
Mailing Address - Phone:410-821-8331
Mailing Address - Fax:410-821-8339
Practice Address - Street 1:7401 OSLER DR
Practice Address - Street 2:SUITE 108
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-7673
Practice Address - Country:US
Practice Address - Phone:410-821-8331
Practice Address - Fax:410-821-8339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA1201261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD218300500Medicaid
MD490002937Medicare PIN
MD21-C0001201Medicare Oscar/Certification
038ZMedicare PIN