Provider Demographics
NPI:1699943290
Name:SOUTHEAST VALLEY ENDOSCOPY CENTER,LLC
Entity type:Organization
Organization Name:SOUTHEAST VALLEY ENDOSCOPY CENTER,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:M
Authorized Official - Last Name:SCHRON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-855-2036
Mailing Address - Street 1:875 S DOBSON RD
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-5710
Mailing Address - Country:US
Mailing Address - Phone:480-899-9800
Mailing Address - Fax:480-899-2994
Practice Address - Street 1:875 S DOBSON RD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-5710
Practice Address - Country:US
Practice Address - Phone:480-855-2900
Practice Address - Fax:480-855-2051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-15
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOSC4443261QE0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZOSC4443OtherSTATE LICENSE
AZOSC4443OtherSTATE LICENSE