Basic Information
| Provider Information | |||||||||
| NPI: | 1104822808 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AGMG ENDOSCOPY CENTER A GENERAL PARTNERSHIP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1211 W LA PALMA AVE | ||||||||
| Address2: | STE 301 | ||||||||
| City: | ANAHEIM | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928012811 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7142840737 | ||||||||
| FaxNumber: | 7142840720 | ||||||||
| Practice Location | |||||||||
| Address1: | 1211 W LA PALMA AVE | ||||||||
| Address2: | STE 301 | ||||||||
| City: | ANAHEIM | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928012811 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7142840737 | ||||||||
| FaxNumber: | 7142840720 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2005 | ||||||||
| LastUpdateDate: | 10/06/2022 | ||||||||
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| AuthorizedOfficialLastName: | LEASURE | ||||||||
| AuthorizedOfficialFirstName: | CAROL | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7147781300 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 10/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.