=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225382757
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEWTON ENDOSCOPY CENTER LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/06/2012
-----------------------------------------------------
Last Update Date | 11/06/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 790 NEWTOWN YARDLEY RD STE. 415
-----------------------------------------------------
City | NEWTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18940-4503
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 251-579-2004
-----------------------------------------------------
Fax | 251-579-2166
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 401 COMMERCE ST STE. 740
-----------------------------------------------------
City | NASHVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37219-2446
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-345-6879
-----------------------------------------------------
Fax | 615-345-6879
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT BOARD OF MANAGERS
-----------------------------------------------------
Name | DAVID W. HOLST
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 615-345-6899
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA1903X
-----------------------------------------------------
Taxonomy Name | Ambulatory Surgical Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------