Healthcare Provider Details

I. General information

NPI: 1447324132
Provider Name (Legal Business Name): ENDOCENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 05/15/2023
Certification Date: 05/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131-A CHEROKEE ROSE LANE
COVINGTON LA
70433-7195
US

IV. Provider business mailing address

PO BOX 848816
BOSTON MA
02284-8816
US

V. Phone/Fax

Practice location:
  • Phone: 985-809-8068
  • Fax: 985-809-7172
Mailing address:
  • Phone: 985-809-8068
  • Fax: 985-893-6908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QE0800X
TaxonomyEndoscopy Clinic/Center
License Number120
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code261QE0800X
TaxonomyEndoscopy Clinic/Center
License Number88
License Number StateLA

VIII. Authorized Official

Name: HAZEL BRAUEN
Title or Position: BUSINESS MANAGER
Credential:
Phone: 985-871-1721