Provider Demographics
NPI:1124075940
Name:ADVANCE ENDOSCOPY CENTER LLC
Entity type:Organization
Organization Name:ADVANCE ENDOSCOPY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NATWARLAL
Authorized Official - Middle Name:V
Authorized Official - Last Name:RAMANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-678-0725
Mailing Address - Street 1:742 S GOVERNORS AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-4111
Mailing Address - Country:US
Mailing Address - Phone:302-678-0725
Mailing Address - Fax:302-678-5505
Practice Address - Street 1:742 S GOVERNORS AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-4111
Practice Address - Country:US
Practice Address - Phone:302-678-0725
Practice Address - Fax:302-678-5505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE2001101949261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE177A22OtherBLUE CROSS BLUE SHIELD
DE0001129928Medicaid
DE113040OtherCOVENTRY
DE113040OtherCOVENTRY
DEA0003Medicare ID - Type Unspecified