Provider Demographics
NPI:1780153874
Name:NGA ENDOSCOPY CENTER LLC
Entity type:Organization
Organization Name:NGA ENDOSCOPY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:R
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:RN, CGRN
Authorized Official - Phone:985-273-3915
Mailing Address - Street 1:7015 HIGHWAY 190 EAST SERVICE RD STE 103
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-4960
Mailing Address - Country:US
Mailing Address - Phone:985-273-3915
Mailing Address - Fax:985-273-3919
Practice Address - Street 1:7015 HIGHWAY 190 EAST SERVICE RD STE 103
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-4960
Practice Address - Country:US
Practice Address - Phone:985-273-3915
Practice Address - Fax:985-273-3919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-19
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy