Provider Demographics
NPI:1821115700
Name:URBANA GI ENDOSCOPY CENTER, LLC
Entity Type:Organization
Organization Name:URBANA GI ENDOSCOPY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:GLOGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:240-453-0963
Mailing Address - Street 1:3280 URBANA PIKE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:IJAMSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21754
Mailing Address - Country:US
Mailing Address - Phone:410-218-7767
Mailing Address - Fax:410-363-4318
Practice Address - Street 1:3280 URBANA PIKE
Practice Address - Street 2:SUITE 104
Practice Address - City:IJAMSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21754
Practice Address - Country:US
Practice Address - Phone:410-218-7767
Practice Address - Fax:410-363-4318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD261QE0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD230ZMedicare PIN