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NPI Code Detail

MEDICARE: ADVANCED ENDOSCOPY CENTER LLC

MEDICARE: ADVANCED 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
1261QA1903XAmbulatory Surgical Clinic/Center

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3P00209165OTHERRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1196006OTHERBLUE CROSS BLUE SHIELD
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1831180272
Entity Type Code : Organization
Provider Name (Legal Business Name) : ADVANCED ENDOSCOPY CENTER LLC
Provider Business Mailing Address
First Line : 11525 OLDE CABIN ROAD
Second Line : SUITE 101
City : CREVE COEUR
State : MO
Zip : 63141-7146
Country : US
Telephone Number : 314-400-9999
Fax Number : 314-400-9990
Provider Business Practice Location Address
First Line : 11525 OLDE CABIN ROAD
Second Line : SUITE 101
City : CREVE COEUR
State : MO
Zip : 63141-7146
Country : US
Telephone Number : 314-400-9999
Fax Number : 314-400-9990
Authorized Official
Title or Position : OFFICER/AUTHORIZED OFFICIAL
Name : CHRISTOPHER HARTSHORN
Credential :
Telephone Number : 314-800-2017
Provider Enumeration Date : 11/03/2005
Last Update Date : 11/08/2024

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Directions to “ADVANCED ENDOSCOPY CENTER LLC ” Practice Location

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