Provider Demographics
NPI:1851568067
Name:WALNUT CREEK ENDOSCOPY CENTER LLC
Entity Type:Organization
Organization Name:WALNUT CREEK ENDOSCOPY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:N
Authorized Official - Last Name:MARCUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:650-331-4650
Mailing Address - Street 1:730 DISTEL DR
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1521
Mailing Address - Country:US
Mailing Address - Phone:650-331-4650
Mailing Address - Fax:
Practice Address - Street 1:365 LENNON LN STE 100
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-5911
Practice Address - Country:US
Practice Address - Phone:650-331-4662
Practice Address - Fax:866-408-1090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-15
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical