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General NPI Number Information
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NPI Number | 1124086863
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Entity Type | Organization
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Legal Business Name | MOORESVILLE ENDOSCOPY CENTER LLC
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Dates
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Enumeration Date | 05/03/2006
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Last Update Date | 06/30/2016
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Provider Practice Location Address
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Address Line | 1215 HADLEY RD STE 101
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City | MOORESVILLE
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State | IN
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Zip | 46158-2905
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Country | US
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Telephone | 317-834-5800
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Fax |
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Provider Business Mailing Address
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Address Line | 5224 S EAST ST SUITE C-9
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City | INDIANAPOLIS
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State | IN
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Zip | 46227-1990
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Country | US
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Telephone | 317-781-3604
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Fax | 317-780-3121
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Authorized Official
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Title or Position | VICE PRESIDENT CEO
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Name | TODD HOOPINGARNER
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Credential |
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Telephone | 317-781-3604
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0800X
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Taxonomy Name | Endoscopy Clinic/Center
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License Number | 040041001
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License Number State | IN
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