Basic Information
| Provider Information | |||||||||
| NPI: | 1841316841 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PACIFIC ENDOSCOPY CENTER, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 401 COMMERCE STREET | ||||||||
| Address2: | SUITE 600 | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153456900 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1029 MAKOLU STREET | ||||||||
| Address2: | SUITE H | ||||||||
| City: | PEARL CITY | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967822890 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8084566420 | ||||||||
| FaxNumber: | 8084566421 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2007 | ||||||||
| LastUpdateDate: | 08/10/2017 | ||||||||
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| AuthorizedOfficialLastName: | LEE | ||||||||
| AuthorizedOfficialFirstName: | DARRELL | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8084566420 | ||||||||
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| 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 | OHCA FSOF 15 | HI | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.