Healthcare Provider Details

I. General information

NPI: 1417957796
Provider Name (Legal Business Name): ENDOSCOPY CENTER OF MONROE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 01/10/2025
Certification Date: 01/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 S 6TH ST
MONROE LA
71201-7568
US

IV. Provider business mailing address

316 S 6TH ST
MONROE LA
71201-7568
US

V. Phone/Fax

Practice location:
  • Phone: 318-327-3107
  • Fax: 318-327-3110
Mailing address:
  • Phone: 318-327-3107
  • Fax: 318-327-3110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QE0800X
TaxonomyEndoscopy Clinic/Center
License Number38
License Number StateLA

VIII. Authorized Official

Name: ANDY WALDO
Title or Position: ADMINISTRATOR
Credential:
Phone: 318-327-3105