Provider Demographics
NPI:1811060700
Name:THE ENDOSCOPY CENTER
Entity type:Organization
Organization Name:THE ENDOSCOPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FACILITY COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAULETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:RN,CCRN
Authorized Official - Phone:530-671-3671
Mailing Address - Street 1:870 SHASTA ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991-4152
Mailing Address - Country:US
Mailing Address - Phone:530-671-3671
Mailing Address - Fax:530-671-3980
Practice Address - Street 1:870 SHASTA ST
Practice Address - Street 2:SUITE 100
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-4152
Practice Address - Country:US
Practice Address - Phone:530-671-3671
Practice Address - Fax:530-671-3980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ42037ZMedicare ID - Type Unspecified