Provider Demographics
NPI:1912900143
Name:E STREET ENDOSCOPY LLC
Entity Type:Organization
Organization Name:E STREET ENDOSCOPY LLC
Other - Org Name:WEST COAST ENDOSCOPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF ADMINITRATIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:JIRAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:727-447-0888
Mailing Address - Street 1:616 E ST
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-3342
Mailing Address - Country:US
Mailing Address - Phone:727-447-0888
Mailing Address - Fax:727-447-0993
Practice Address - Street 1:616 E ST
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3342
Practice Address - Country:US
Practice Address - Phone:727-447-0888
Practice Address - Fax:727-447-0993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1145261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002689600Medicaid
FL1972392OtherFIRST HEALTH
FL285376OtherAVMED
FL2894273OtherAETNA HMO
FL6A5OtherBLUE CROSS BLUE SHIELD
FL9131340001OtherCIGNA
FL490005538OtherRAILROAD MEDICARE
FL106705-01OtherCITRUS HEALTHCARE
FL7337369OtherAETNA
FL187028OtherAMERIGROUP
FL209367OtherWELLCARE
FL002689600Medicaid