MEDICARE: THE EASTSIDE 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	261QA1903X	Ambulatory Surgical Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	15949	OTHER		AAAHC ACCREDITATION
2	50D0923026	OTHER	WA	CLIA NUMBER
3	EA0308	OTHER	WA	REGENCE BS
4	MTS-3102	OTHER	WA	STATE LICENSE
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1992702443
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE EASTSIDE ENDOSCOPY CENTER LLC

Provider Business Mailing Address
First Line	:	1135 116TH AVE NE
Second Line	:
City	:	BELLEVUE
State	:	WA
Zip	:	98004-4623
Country	:	US
Telephone Number	:	425-544-7684
Fax Number	:	425-462-8021

Provider Business Practice Location Address
First Line	:	1135 116TH AVE NE
Second Line	:	SUITE 570
City	:	BELLEVUE
State	:	WA
Zip	:	98004-4623
Country	:	US
Telephone Number	:	425-451-7335
Fax Number	:	425-451-1226

Authorized Official
Title or Position	:	COO
Name	:	NICOLAS GORALSKY
Credential	:
Telephone Number	:	253-383-8342

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	03/07/2023

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Directions to “THE EASTSIDE ENDOSCOPY CENTER LLC ” Practice Location

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