Provider Demographics
NPI:1821141441
Name:INLAND ENDOSCOPY CENTER, INC
Entity Type:Organization
Organization Name:INLAND ENDOSCOPY CENTER, INC
Other - Org Name:MOUNTAIN VIEW SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:E
Authorized Official - Last Name:LAMOUREUX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-796-7803
Mailing Address - Street 1:10408 INDUSTRIAL CIRCLE
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-4548
Mailing Address - Country:US
Mailing Address - Phone:909-796-7803
Mailing Address - Fax:909-255-7287
Practice Address - Street 1:10408 INDUSTRIAL CIRCLE
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-4548
Practice Address - Country:US
Practice Address - Phone:909-796-7803
Practice Address - Fax:909-255-7287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QA1903X
CA240000549261QE0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZH3609ZMedicare UPIN