Healthcare Provider Details

I. General information

NPI: 1528385200
Provider Name (Legal Business Name): ESCONDIDO CA ENDOSCOPY ASC LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2010
Last Update Date: 09/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

488 E VALLEY PKWY SUITE 110
ESCONDIDO CA
92025-3363
US

IV. Provider business mailing address

20 BURTON HILLS BLVD SUITE 500
NASHVILLE TN
37215-6197
US

V. Phone/Fax

Practice location:
  • Phone: 760-735-6290
  • Fax:
Mailing address:
  • Phone: 615-240-3820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number StateCA

VIII. Authorized Official

Name: MS. BILLIE PAYNE
Title or Position: PRESIDENT OF LP
Credential:
Phone: 615-665-1283