Provider Demographics
NPI:1881645810
Name:ANMED ENTERPRISES INC - UPSTATE ENDOSCOPY CENTER INC LLC
Entity Type:Organization
Organization Name:ANMED ENTERPRISES INC - UPSTATE ENDOSCOPY CENTER INC LLC
Other - Org Name:UPSTATE ENDOSCOPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:WORTHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:864-716-6555
Mailing Address - Street 1:1922B MCCONNELL SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-2642
Mailing Address - Country:US
Mailing Address - Phone:864-716-6555
Mailing Address - Fax:864-716-6599
Practice Address - Street 1:1922B MCCONNELL SPRINGS RD
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-2642
Practice Address - Country:US
Practice Address - Phone:864-716-6555
Practice Address - Fax:864-716-6599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCASC055Medicaid
Q33571001Medicare Oscar/Certification
Q33571001Medicare PIN