Basic Information
| Provider Information | |||||||||
| NPI: | 1154328243 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SALINAS ENDOSCOPY CENTER LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 401 COMMERCE ST STE 600 | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372192518 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153456900 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1081 LOS PALOS DR | ||||||||
| Address2: | SUITE - A | ||||||||
| City: | SALINAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939013916 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8317711458 | ||||||||
| FaxNumber: | 8317833089 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2005 | ||||||||
| LastUpdateDate: | 10/29/2018 | ||||||||
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| AuthorizedOfficialLastName: | PAYNE | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6153456900 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QE0800X | 22078 | CA | N | Ambulatory Health Care Facilities | Clinic/Center | Endoscopy | 261QA1903X | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
ID Information
| ID | Type | State | Issuer | Description | ZZZH2702Z | 01 | CA | BLUE SHIELD PROVIDER NUMBER | OTHER |