Healthcare Provider Details

I. General information

NPI: 1528032711
Provider Name (Legal Business Name): COLUMBIA ENDOSCOPY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 06/12/2020
Certification Date: 06/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 PORTLAND ST
COLUMBIA MO
65201-6525
US

IV. Provider business mailing address

208 PORTLAND ST
COLUMBIA MO
65201-6525
US

V. Phone/Fax

Practice location:
  • Phone: 573-449-3500
  • Fax: 573-449-5097
Mailing address:
  • Phone: 573-449-3500
  • Fax: 573-449-5097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number143-1
License Number StateMO

VIII. Authorized Official

Name: DR. NICOLAS LLORENS
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 573-449-3500