MEDICARE: BRAWLEY ENDOSCOPY & SURGERY MED CTR

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	090000507	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	090000507	OTHER	CA	STATE LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346208642
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRAWLEY ENDOSCOPY & SURGERY MED CTR

Provider Business Mailing Address
First Line	:	PO BOX 2601
Second Line	:
City	:	EL CENTRO
State	:	CA
Zip	:	92244-2601
Country	:	US
Telephone Number	:	760-352-3000
Fax Number	:	760-352-1985

Provider Business Practice Location Address
First Line	:	1550 N IMPERIAL AVE
Second Line	:	SUITE 3
City	:	EL CENTRO
State	:	CA
Zip	:	92243-6304
Country	:	US
Telephone Number	:	760-352-3000
Fax Number	:	760-352-1985

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. MAHOMED SULIMAN
Credential	:	M.D.
Telephone Number	:	760-352-3000

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	07/09/2014

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Directions to “BRAWLEY ENDOSCOPY & SURGERY MED CTR ” Practice Location

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