Provider Demographics
NPI:1205809795
Name:OAKHURST ENDOSCOPY ASC LLC
Entity type:Organization
Organization Name:OAKHURST ENDOSCOPY ASC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF MANAGER OF LLC
Authorized Official - Prefix:MS
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:
Authorized Official - Last Name:CLENDENIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-665-1283
Mailing Address - Street 1:1A BURTON HILLS BLVD
Mailing Address - Street 2:ATTN: L&C
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-6103
Mailing Address - Country:US
Mailing Address - Phone:732-517-8885
Mailing Address - Fax:732-517-0304
Practice Address - Street 1:1907 HIGHWAY 35
Practice Address - Street 2:SUITE 9
Practice Address - City:OAKHURST
Practice Address - State:NJ
Practice Address - Zip Code:07755-2765
Practice Address - Country:US
Practice Address - Phone:732-517-8885
Practice Address - Fax:732-517-0304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-07
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNONE REQUIRED261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3385809Medicaid
NJ31-C0001036Medicare Oscar/Certification
NJ311036Medicare PIN