Provider Demographics
NPI:1386730950
Name:ENDOSCOPY CENTER OF GULF BREEZE LLC
Entity type:Organization
Organization Name:ENDOSCOPY CENTER OF GULF BREEZE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:L
Authorized Official - Last Name:CARTEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-474-8988
Mailing Address - Street 1:1116 GULF BREEZE PARKWAY
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32561
Mailing Address - Country:US
Mailing Address - Phone:850-934-4438
Mailing Address - Fax:850-934-4211
Practice Address - Street 1:1116 GULF BREEZE PARKWAY
Practice Address - Street 2:
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32561
Practice Address - Country:US
Practice Address - Phone:850-934-4438
Practice Address - Fax:850-934-4211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
7956778OtherAETNA
9256246OtherCIGNA
987294OtherUSA HEALTH NETWORK
FL6M1OtherBCBS OF FLORIDA
P00326955OtherRAILROAD MEDICARE
6M1OtherHEALTH OPTIONS
FL6M1OtherBCBS OF FLORIDA
FLF1463Medicare PIN