GASTROINTESTINAL DIAGNOSTIC ENDOSCOPY WOODSTOCK LLC NPI 1760778765

NPI Information

NPI: 1760778765
Provider Name: GASTROINTESTINAL DIAGNOSTIC ENDOSCOPY WOODSTOCK, LLC

Doing Business As: TOWN LAKE ENDOSCOPY CENTER

Classification: Clinic/Center - 261QA1903X
Entity Type: Organization

Specialization: Ambulatory Surgical

CLIA Number: 11D2029444

Address:
118 MILL ST
SUITE 100
WOODSTOCK, GA
ZIP 30188
Phone: (770) 226-9070
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GASTROINTESTINAL DIAGNOSTIC ENDOSCOPY WOODSTOCK, LLC is an ambulatory surgical clinic center in Woodstock, GA. GASTROINTESTINAL DIAGNOSTIC ENDOSCOPY WOODSTOCK, LLC NPI is 1760778765. The provider is registered as an organization entity type.
The provider Is Doing Business As Town Lake Endoscopy Center.

The provider's business location address is:

118 MILL ST
SUITE 100
WOODSTOCK, GA
ZIP 30188-879
Phone: (770) 226-9070
Fax: (770) 226-8863

The provider's authorized official is Debora S Rowell .
The authorized official title is Manager and has the following contact phone number (678) 741-2317.

The CLIA number assigned to this NPI record is 11D2029444 - ambulatory surgery center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 6/28/2011 and was last updated on 3/11/2015.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QE0800X	Clinic/Center	Endoscopy			No
2	261QA1903X	Clinic/Center	Ambulatory Surgical	028-451	GEORGIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	202G497327	MEDICARE UPIN	GEORGIA
2	11C0001379	MEDICARE OSCAR/CERTIFICATION	GEORGIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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