Provider Demographics
NPI:1720052012
Name:DENVER ENDOSCOPY CENTER LLC
Entity Type:Organization
Organization Name:DENVER ENDOSCOPY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:TROUILLOT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-344-4844
Mailing Address - Street 1:11221 ROE AVENUE
Mailing Address - Street 2:SUITE 320
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1878
Mailing Address - Country:US
Mailing Address - Phone:303-344-4844
Mailing Address - Fax:303-344-4564
Practice Address - Street 1:8155 EAST 1ST AVENUE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80230
Practice Address - Country:US
Practice Address - Phone:303-344-4844
Practice Address - Fax:303-344-4564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-14
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0121261QA1903X
CO16H513261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO99870550Medicaid
CO99870550Medicaid