Basic Information
| Provider Information | |||||||||
| NPI: | 1861501835 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ENDOSCOPY CENTER OF SOUTHEAST MASSACHUSETTS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 PEARL ST | ||||||||
| Address2: | ST 1800 | ||||||||
| City: | BROCKTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 023012864 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5085883174 | ||||||||
| FaxNumber: | 5085883179 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 PEARL ST | ||||||||
| Address2: | ST 1200 | ||||||||
| City: | BROCKTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 023012864 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5085883174 | ||||||||
| FaxNumber: | 5085883179 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2006 | ||||||||
| LastUpdateDate: | 03/05/2013 | ||||||||
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| AuthorizedOfficialLastName: | ISSA | ||||||||
| AuthorizedOfficialFirstName: | MARCIA | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 5085883174 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | 63138 | MA | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.