MEDICARE: FREDERICKSBURG 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

General Provider Information

NPI Number	:	1306486634
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FREDERICKSBURG ENDOSCOPY CENTER, LLC

Provider Business Mailing Address
First Line	:	1211 CENTRAL PARK BLVD
Second Line	:
City	:	FREDERICKSBURG
State	:	VA
Zip	:	22401-4912
Country	:	US
Telephone Number	:	540-408-0800
Fax Number	:	540-408-0810

Provider Business Practice Location Address
First Line	:	1211 CENTRAL PARK BLVD
Second Line	:
City	:	FREDERICKSBURG
State	:	VA
Zip	:	22401-4912
Country	:	US
Telephone Number	:	540-408-0800
Fax Number	:	540-408-0810

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	YOLANDA M KAY
Credential	:
Telephone Number	:	540-408-0800

Provider Enumeration Date	:	01/15/2020
Last Update Date	:	11/04/2025

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