MEDICARE: METHODIST ENDOSCOPY CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center	PENDING	NE

General Provider Information

NPI Number	:	1083946149
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	METHODIST ENDOSCOPY CENTER LLC

Provider Business Mailing Address
First Line	:	515 NORTH 162 AVENUE
Second Line	:	SUITE 201
City	:	OMAHA
State	:	NE
Zip	:	68118-2540
Country	:	US
Telephone Number	:	402-505-8708
Fax Number	:	402-505-8748

Provider Business Practice Location Address
First Line	:	515 NORTH 162 AVENUE
Second Line	:	SUITE 201
City	:	OMAHA
State	:	NE
Zip	:	68118-2540
Country	:	US
Telephone Number	:	402-505-8708
Fax Number	:	402-505-8748

Authorized Official
Title or Position	:	OWNER AND MANAGER
Name	:	DR. TYRON A. ALLI
Credential	:	M.D.
Telephone Number	:	402-397-7057

Provider Enumeration Date	:	02/01/2010
Last Update Date	:	02/13/2010

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Directions to “METHODIST ENDOSCOPY CENTER LLC ” Practice Location

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