Provider Demographics
NPI:1528053311
Name:AMERICAN ENDOSCOPY CENTER, P.C.
Entity type:Organization
Organization Name:AMERICAN ENDOSCOPY CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MENE
Authorized Official - Middle Name:SUGAGE
Authorized Official - Last Name:ZUA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-868-3131
Mailing Address - Street 1:1308 BRIARVILLE RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:TN
Mailing Address - Zip Code:37115-5127
Mailing Address - Country:US
Mailing Address - Phone:615-868-3131
Mailing Address - Fax:615-515-0205
Practice Address - Street 1:1308 BRIARVILLE RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:TN
Practice Address - Zip Code:37115-5127
Practice Address - Country:US
Practice Address - Phone:615-868-3131
Practice Address - Fax:615-515-0205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-17
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN160261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3739615Medicaid
3739615Medicare ID - Type UnspecifiedMEDICARE NUMBER