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NPI Code Detail

MEDICARE: ENDOSCOPY CENTER OF LAWRENCE

MEDICARE: ENDOSCOPY CENTER OF LAWRENCE
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
1261QA1903XAmbulatory Surgical Clinic/CenterS023003KS

General Provider Information

NPI Number : 1417066135
Entity Type Code : Organization
Provider Name (Legal Business Name) : ENDOSCOPY CENTER OF LAWRENCE
Provider Business Mailing Address
First Line : 4525 W 6TH ST STE 100
Second Line :
City : LAWRENCE
State : KS
Zip : 66049-7700
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4525 W 6TH ST STE 100
Second Line :
City : LAWRENCE
State : KS
Zip : 66049-7700
Country : US
Telephone Number : 785-843-5160
Fax Number :
Authorized Official
Title or Position : ADMINISTRATOR
Name : MARY ANN ICE
Credential :
Telephone Number : 785-843-5160
Provider Enumeration Date : 08/29/2006
Last Update Date : 10/30/2007

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Directions to “ENDOSCOPY CENTER OF LAWRENCE ” Practice Location

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