Healthcare Provider Details

I. General information

NPI: 1205809795
Provider Name (Legal Business Name): OAKHURST ENDOSCOPY ASC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 09/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1907 HIGHWAY 35 SUITE 9
OAKHURST NJ
07755-2765
US

IV. Provider business mailing address

1A BURTON HILLS BLVD ATTN: L&C
NASHVILLE TN
37215-6103
US

V. Phone/Fax

Practice location:
  • Phone: 732-517-8885
  • Fax: 732-517-0304
Mailing address:
  • Phone: 732-517-8885
  • Fax: 732-517-0304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberNONE REQUIRED
License Number StateNJ

VIII. Authorized Official

Name: MS. PHILLIP CLENDENIN
Title or Position: CHIEF MANAGER OF LLC
Credential:
Phone: 615-665-1283