Provider Demographics
NPI:1669460002
Name:CARSON ENDOSCOPY CENTER, LLC
Entity type:Organization
Organization Name:CARSON ENDOSCOPY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:775-329-4600
Mailing Address - Street 1:PO BOX 842668
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90084-2660
Mailing Address - Country:US
Mailing Address - Phone:775-329-4600
Mailing Address - Fax:775-324-4314
Practice Address - Street 1:1385 VISTA LANE
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89703-4643
Practice Address - Country:US
Practice Address - Phone:775-884-4567
Practice Address - Fax:775-884-4569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-10
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV37791261QE0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV4613003Medicaid
NVV30163Medicare PIN