Provider Demographics
NPI:1295988053
Name:PRIMARY CARE ENDOSCOPY OF COLUMBIA, LLC
Entity type:Organization
Organization Name:PRIMARY CARE ENDOSCOPY OF COLUMBIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, BOARD OF MANAGERS
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:HOLST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-345-6899
Mailing Address - Street 1:3100 W END AVE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1320
Mailing Address - Country:US
Mailing Address - Phone:615-345-6900
Mailing Address - Fax:615-345-6905
Practice Address - Street 1:1735 TAYLOR ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-3452
Practice Address - Country:US
Practice Address - Phone:803-254-8449
Practice Address - Fax:803-254-8984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-24
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical