Basic Information
| Provider Information | |||||||||
| NPI: | 1558335448 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THE ENDOSCOPY AND COLONOSCOPY CENTER, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 VILLAGE SQUARE | ||||||||
| Address2: | |||||||||
| City: | HAZELWOOD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 63042 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3143738931 | ||||||||
| FaxNumber: | 3143738935 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 VILLAGE SQUARE | ||||||||
| Address2: | |||||||||
| City: | HAZELWOOD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 63042 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3143738931 | ||||||||
| FaxNumber: | 3143738935 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | MARGOLIS | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3143738931 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | 170-0 | MO | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.