MEDICARE: RIDGELINE ENDOSCOPY CENTER L.C.

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	261QA1903X	Ambulatory Surgical Clinic/Center	2004-ASF-9993	UT

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	49004666	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154304749
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIDGELINE ENDOSCOPY CENTER L.C.

Provider Business Mailing Address
First Line	:	6028 S RIDGELINE DR
Second Line	:	SUITE 100
City	:	SOUTH OGDEN
State	:	UT
Zip	:	84405-6914
Country	:	US
Telephone Number	:	801-475-4988
Fax Number	:	801-475-4948

Provider Business Practice Location Address
First Line	:	6028 S RIDGELINE DR
Second Line	:	SUITE 100
City	:	SOUTH OGDEN
State	:	UT
Zip	:	84405-6914
Country	:	US
Telephone Number	:	801-475-4988
Fax Number	:	801-475-4948

Authorized Official
Title or Position	:	GENERAL PARTNER
Name	:	DR. JOHN LOWE
Credential	:	M.D.
Telephone Number	:	801-475-5400

Provider Enumeration Date	:	11/28/2005
Last Update Date	:	08/22/2020

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Directions to “RIDGELINE ENDOSCOPY CENTER L.C. ” Practice Location

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