MEDICARE: WELLSPAN 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
1	261QE0800X	Endoscopy Clinic/Center

General Provider Information

NPI Number	:	1861268559
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELLSPAN ENDOSCOPY CENTER LLC

Provider Business Mailing Address
First Line	:	601 MEMORY LN
Second Line	:
City	:	YORK
State	:	PA
Zip	:	17402-2231
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4150 BARRETT BLVD
Second Line	:
City	:	EPHRATA
State	:	PA
Zip	:	17522-8979
Country	:	US
Telephone Number	:	717-859-5160
Fax Number	:

Authorized Official
Title or Position	:	VP
Name	:	ANDREW WALKER
Credential	:
Telephone Number	:	859-250-5720

Provider Enumeration Date	:	12/04/2023
Last Update Date	:	12/04/2023

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