MEDICARE: ENDOSCOPY CENTER WEST 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	:	1780641225
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENDOSCOPY CENTER WEST LLC

Provider Business Mailing Address
First Line	:	3654 WERK RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45248-4900
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3654 WERK RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45248-4900
Country	:	US
Telephone Number	:	513-451-6001
Fax Number	:

Authorized Official
Title or Position	:	VP/SECRETARY
Name	:	RICHARD L SHARFF JR.
Credential	:
Telephone Number	:	205-545-2572

Provider Enumeration Date	:	04/27/2006
Last Update Date	:	06/01/2009

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