# STEWARD MEDICAL GROUP PENNSYLVANIA ENDOSCOPY LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Twin Rivers Endoscopy Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1386185858
- **Authorized official:** ASHLEY KOCH (CFO)
- **Authorized official phone:** (617) 562-5359

## Contact information

- **Practice address:** 77 WARREN ST, BRIGHTON, MA 02135-3601
- **Practice address phone:** (617) 562-5359
- **Mailing address:** 77 WARREN ST, BRIGHTON, MA 02135-3601
- **Mailing address phone:** (617) 562-5359

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |
| 207RG0100X | Gastroenterology Physician | — | NULL | Yes |
| 207RG0100X | Gastroenterology Physician | — | — | Yes |
| 363A00000X | Physician Assistant | — | NULL | — |
| 363A00000X | Physician Assistant | — | — | — |
| 363L00000X | Nurse Practitioner | — | NULL | — |
| 363L00000X | Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 03/16/2017
- **Last updated:** 03/17/2017