MEDICARE: THE ROME ENDOSCOPY CENTER

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	057045	GA

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	:	1356305916
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE ROME ENDOSCOPY CENTER

Provider Business Mailing Address
First Line	:	11 JOHN MADDOX DR NW
Second Line	:
City	:	ROME
State	:	GA
Zip	:	30165-1413
Country	:	US
Telephone Number	:	706-295-3992
Fax Number	:

Provider Business Practice Location Address
First Line	:	11 JOHN MADDOX DR NW
Second Line	:
City	:	ROME
State	:	GA
Zip	:	30165-1413
Country	:	US
Telephone Number	:	706-295-3992
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	KEITH BALDWIN
Credential	:
Telephone Number	:	706-292-3036

Provider Enumeration Date	:	04/12/2006
Last Update Date	:	05/06/2014

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Directions to “THE ROME ENDOSCOPY CENTER ” Practice Location

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