Provider Demographics
NPI:1013962380
Name:WOODLANDS ENDOSCOPY CENTR, LTD.
Entity Type:Organization
Organization Name:WOODLANDS ENDOSCOPY CENTR, LTD.
Other - Org Name:WOODLANDS ENDOSCOPY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF MANAGER OF LLC
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:A
Authorized Official - Last Name:HOLDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-665-1283
Mailing Address - Street 1:111 VISION PARK BLVD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77384-3002
Mailing Address - Country:US
Mailing Address - Phone:936-321-8910
Mailing Address - Fax:936-321-8913
Practice Address - Street 1:111 VISION PARK BLVD
Practice Address - Street 2:SUITE 160
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77384-3002
Practice Address - Country:US
Practice Address - Phone:936-321-8910
Practice Address - Fax:936-321-8913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008224261QE0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ASC-330Medicare PIN