Provider Demographics
NPI:1902815749
Name:PHYSICIANS ENDOSCOPY CENTER, LTD., LLP
Entity type:Organization
Organization Name:PHYSICIANS ENDOSCOPY CENTER, LTD., LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:HAN
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:MHA
Authorized Official - Phone:713-587-0909
Mailing Address - Street 1:3030 S GESSNER RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77063-3765
Mailing Address - Country:US
Mailing Address - Phone:713-587-0909
Mailing Address - Fax:713-587-0912
Practice Address - Street 1:3030 S GESSNER RD
Practice Address - Street 2:SUITE 150
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77063-3765
Practice Address - Country:US
Practice Address - Phone:713-587-0909
Practice Address - Fax:713-587-0912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-07
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX007904261QE0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1567430Medicaid
TXASC158Medicare ID - Type UnspecifiedAMBULATORY SURGERY CENTER