=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669460002
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CARSON ENDOSCOPY CENTER, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/10/2005
-----------------------------------------------------
Last Update Date | 10/20/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1385 VISTA LANE
-----------------------------------------------------
City | CARSON CITY
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89703-4643
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-884-4567
-----------------------------------------------------
Fax | 775-884-4569
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1385 VISTA LN
-----------------------------------------------------
City | CARSON CITY
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89703-4643
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-884-4567
-----------------------------------------------------
Fax | 775-884-4569
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | DR. JASON COLLINS
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 775-329-4600
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QE0800X
-----------------------------------------------------
Taxonomy Name | Endoscopy Clinic/Center
-----------------------------------------------------
License Number | 37791
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------