MEDICARE: CAPSULE ENDOSCOPY SERVICES, 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	247200000X	Other Technician

General Provider Information

NPI Number	:	1538195870
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAPSULE ENDOSCOPY SERVICES, LLC

Provider Business Mailing Address
First Line	:	PO BOX 2615
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67201-2615
Country	:	US
Telephone Number	:	877-502-1209
Fax Number	:	877-219-2990

Provider Business Practice Location Address
First Line	:	2021 N AMIDON AVE
Second Line	:	SUITE 13
City	:	WICHITA
State	:	KS
Zip	:	67203-2100
Country	:	US
Telephone Number	:	877-502-1209
Fax Number	:	877-219-2990

Authorized Official
Title or Position	:	COO
Name	:	MRS. TEVRA VENN
Credential	:
Telephone Number	:	877-502-1209

Provider Enumeration Date	:	06/25/2006
Last Update Date	:	08/22/2020

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