Healthcare Provider Details

I. General information

NPI: 1154328243
Provider Name (Legal Business Name): SALINAS ENDOSCOPY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 10/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1081 LOS PALOS DR SUITE - A
SALINAS CA
93901-3916
US

IV. Provider business mailing address

401 COMMERCE ST STE 600
NASHVILLE TN
37219-2518
US

V. Phone/Fax

Practice location:
  • Phone: 831-771-1458
  • Fax: 831-783-3089
Mailing address:
  • Phone: 615-345-6900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QE0800X
TaxonomyEndoscopy Clinic/Center
License Number22078
License Number StateCA

VIII. Authorized Official

Name: MARK PAYNE
Title or Position: PRESIDENT
Credential:
Phone: 615-345-6900