Basic Information
| Provider Information | |||||||||
| NPI: | 1659526457 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORWOOD ENDOSCOPY CENTER, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4746 MONTGOMERY RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | NORWOOD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452122637 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 4746 MONTGOMERY RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | NORWOOD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452122637 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5137516667 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/20/2008 | ||||||||
| LastUpdateDate: | 11/20/2008 | ||||||||
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| AuthorizedOfficialLastName: | WALKER | ||||||||
| AuthorizedOfficialFirstName: | DANIEL | ||||||||
| AuthorizedOfficialMiddleName: | G | ||||||||
| AuthorizedOfficialTitleorPosition: | COO | ||||||||
| AuthorizedOfficialTelephone: | 5137516667 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | OH | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.