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NPI Code Detail

MEDICARE: ENDOSCOPY CENTER OF SANTA ROSA

MEDICARE: ENDOSCOPY CENTER OF SANTA ROSA
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
1261QE0800XEndoscopy Clinic/CenterCA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1AS1557OTHERCABLUE CROSS
2ZZZH49112OTHERCABLUE SHIELD

General Provider Information

NPI Number : 1467478818
Entity Type Code : Organization
Provider Name (Legal Business Name) : ENDOSCOPY CENTER OF SANTA ROSA
Provider Business Mailing Address
First Line : 1200 SONOMA AVE
Second Line : SUITE 2
City : SANTA ROSA
State : CA
Zip : 95405-6664
Country : US
Telephone Number : 707-571-2192
Fax Number : 707-571-2194
Provider Business Practice Location Address
First Line : 1200 SONOMA AVE
Second Line : SUITE 2
City : SANTA ROSA
State : CA
Zip : 95405-6664
Country : US
Telephone Number : 707-571-2192
Fax Number : 707-571-2194
Authorized Official
Title or Position : MANAGER
Name : MRS. MARION AULD
Credential : RN
Telephone Number : 707-571-2192
Provider Enumeration Date : 07/15/2006
Last Update Date : 07/21/2022

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Directions to “ENDOSCOPY CENTER OF SANTA ROSA ” Practice Location

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