MEDICARE: NEXTGEN ENDOSCOPY CENTRE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QE0800X	Endoscopy Clinic/Center

General Provider Information

NPI Number	:	1043576374
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEXTGEN ENDOSCOPY CENTRE LLC

Provider Business Mailing Address
First Line	:	1611 POND RD
Second Line	:
City	:	ALLENTOWN
State	:	PA
Zip	:	18104-2258
Country	:	US
Telephone Number	:	610-366-8555
Fax Number	:	610-366-8550

Provider Business Practice Location Address
First Line	:	1611 POND RD
Second Line	:
City	:	ALLENTOWN
State	:	PA
Zip	:	18104-2258
Country	:	US
Telephone Number	:	610-366-8555
Fax Number	:	610-366-8550

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. SHEILA KLECKNER
Credential	:
Telephone Number	:	610-366-8555

Provider Enumeration Date	:	04/11/2012
Last Update Date	:	07/11/2012

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