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General NPI Number Information
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NPI Number | 1841255775
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Entity Type | Organization
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Legal Business Name | DUBUQUE ENDOSCOPY CENTER LC
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Dates
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Enumeration Date | 04/20/2006
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Last Update Date | 03/19/2012
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Provider Practice Location Address
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Address Line | 1515 DELHI ST STE 500
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City | DUBUQUE
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State | IA
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Zip | 52001-6320
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Country | US
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Telephone | 563-589-4060
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Fax | 563-589-4062
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Provider Business Mailing Address
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Address Line | 1515 DELHI ST STE 500
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City | DUBUQUE
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State | IA
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Zip | 52001-6320
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Country | US
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Telephone | 563-589-4060
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Fax | 563-589-4062
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MICHAEL J. BERG
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Credential |
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Telephone | 563-589-4057
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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