Provider Demographics
NPI:1902017288
Name:AMG ENDOSCOPY CENTER LTD
Entity Type:Organization
Organization Name:AMG ENDOSCOPY CENTER LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RASHIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:R
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-680-5833
Mailing Address - Street 1:1105 W PARK AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-2567
Mailing Address - Country:US
Mailing Address - Phone:847-680-5833
Mailing Address - Fax:847-680-5881
Practice Address - Street 1:1105 W PARK AVE STE 1
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-2567
Practice Address - Country:US
Practice Address - Phone:847-680-5833
Practice Address - Fax:847-680-5881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QE0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy