MEDICARE: ENDOSCOPY CENTER OF MONROE

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	38	LA
2	261QA1903X	Ambulatory Surgical Clinic/Center

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P2590	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	2059C	OTHER		BLUE CROSS OF LOUISIANA

General Provider Information

NPI Number	:	1417957796
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENDOSCOPY CENTER OF MONROE

Provider Business Mailing Address
First Line	:	316 S 6TH ST
Second Line	:
City	:	MONROE
State	:	LA
Zip	:	71201-7568
Country	:	US
Telephone Number	:	318-327-3107
Fax Number	:	318-327-3110

Provider Business Practice Location Address
First Line	:	316 S 6TH ST
Second Line	:
City	:	MONROE
State	:	LA
Zip	:	71201-7568
Country	:	US
Telephone Number	:	318-327-3107
Fax Number	:	318-327-3110

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	ANDY WALDO
Credential	:
Telephone Number	:	318-327-3105

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	01/10/2025

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Directions to “ENDOSCOPY CENTER OF MONROE ” Practice Location

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