MEDICARE: SALINAS 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	261QE0800X	Endoscopy Clinic/Center	22078	CA
2	261QA1903X	Ambulatory Surgical Clinic/Center		CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ZZZH2702Z	OTHER	CA	BLUE SHIELD PROVIDER NUMBER

General Provider Information

NPI Number	:	1154328243
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SALINAS ENDOSCOPY CENTER LLC

Provider Business Mailing Address
First Line	:	401 COMMERCE ST STE 600
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37219-2518
Country	:	US
Telephone Number	:	615-345-6900
Fax Number	:

Provider Business Practice Location Address
First Line	:	1081 LOS PALOS DR
Second Line	:	SUITE - A
City	:	SALINAS
State	:	CA
Zip	:	93901-3916
Country	:	US
Telephone Number	:	831-771-1458
Fax Number	:	831-783-3089

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MARK PAYNE
Credential	:
Telephone Number	:	615-345-6900

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	10/29/2018

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Directions to “SALINAS ENDOSCOPY CENTER LLC ” Practice Location

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