Provider Demographics
NPI:1831180272
Name:ADVANCED ENDOSCOPY CENTER LLC
Entity type:Organization
Organization Name:ADVANCED ENDOSCOPY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:HARTSHORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-800-2017
Mailing Address - Street 1:11525 OLDE CABIN ROAD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CREVE COEUR
Mailing Address - State:MO
Mailing Address - Zip Code:63141-7146
Mailing Address - Country:US
Mailing Address - Phone:314-400-9999
Mailing Address - Fax:314-400-9990
Practice Address - Street 1:11525 OLDE CABIN ROAD
Practice Address - Street 2:SUITE 101
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-7146
Practice Address - Country:US
Practice Address - Phone:314-400-9999
Practice Address - Fax:314-400-9990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-03
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
196006OtherBLUE CROSS BLUE SHIELD
MO507304905Medicaid
P00209165OtherRAILROAD MEDICARE
MO507304905Medicaid