Healthcare Provider Details

I. General information

NPI: 1275764334
Provider Name (Legal Business Name): ENDOSCOPY CENTER OF SOUTH BAY LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2009
Last Update Date: 09/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23560 MADISON ST SUITE 109
TORRANCE CA
90505-4708
US

IV. Provider business mailing address

20 BURTON HILLS BLVD SUITE 500
NASHVILLE TN
37215-6154
US

V. Phone/Fax

Practice location:
  • Phone: 310-325-6331
  • Fax: 310-325-6335
Mailing address:
  • Phone: 615-665-1283
  • Fax: 615-234-1720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

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