MEDICARE: BAYTOWN ENDOSCOPY CENTER, 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	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1184991341
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAYTOWN ENDOSCOPY CENTER, LLC

Provider Business Mailing Address
First Line	:	PO BOX 2429
Second Line	:
City	:	BAYTOWN
State	:	TX
Zip	:	77522-2429
Country	:	US
Telephone Number	:	281-425-3900
Fax Number	:	281-425-3996

Provider Business Practice Location Address
First Line	:	910 N HIGHWAY 146
Second Line	:
City	:	BAYTOWN
State	:	TX
Zip	:	77520-2252
Country	:	US
Telephone Number	:	281-425-3900
Fax Number	:	281-425-3996

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. NILOFAR S JIWANI
Credential	:
Telephone Number	:	281-425-3900

Provider Enumeration Date	:	11/16/2011
Last Update Date	:	11/16/2011

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