Healthcare Provider Details

I. General information

NPI: 1326142878
Provider Name (Legal Business Name): LEBANON ENDOSCOPY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 10/11/2024
Certification Date: 10/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PHYSICIANS WAY SUITE 340
LEBANON TN
37090-8103
US

IV. Provider business mailing address

100 PHYSICIANS WAY SUITE 340
LEBANON TN
37090-8103
US

V. Phone/Fax

Practice location:
  • Phone: 615-446-9532
  • Fax: 615-466-9536
Mailing address:
  • Phone: 615-446-9532
  • Fax: 615-466-9536

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 NumberPENDING
License Number StateTN

VIII. Authorized Official

Name: KRISTEN OCONNOR
Title or Position: OFFICER/AUTHORIZED OFFICIAL
Credential:
Phone: 615-376-7315