Provider Demographics
NPI:1780923128
Name:MACOMB ENDOSCOPY CENTER PLC
Entity type:Organization
Organization Name:MACOMB ENDOSCOPY CENTER PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REVENUE CYCLE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-252-8698
Mailing Address - Street 1:1701 SOUTH BLVD E
Mailing Address - Street 2:STE 300
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-6122
Mailing Address - Country:US
Mailing Address - Phone:248-844-9782
Mailing Address - Fax:586-726-8557
Practice Address - Street 1:48801 ROMEO PLANK RD
Practice Address - Street 2:SUITE 101
Practice Address - City:MACOMB
Practice Address - State:MI
Practice Address - Zip Code:48044-2165
Practice Address - Country:US
Practice Address - Phone:586-726-8423
Practice Address - Fax:586-726-8557
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MACOMB ENDOSCOPY CENTER, PLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-02-05
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical