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Organization
COLONOSCOPY CENTER INC
Active
Organization
COLONOSCOPY CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANDY STOCKTON (PRACTICE ADMINISTRATOR)
(402) 343-1122
Entity
Organization
Contact information
Practice address
9850 NICHOLAS STREET, SUITE 100, OMAHA, NE 68114
(402) 343-1122
(402) 343-1177
Mailing address
9850 NICHOLAS STREET, SUITE 100, OMAHA, NE 68114
(402) 343-1122
(402) 343-1177
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
ASC038
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0570762
—
IA
05
—
10025038900
—
NE
01
—
98448
BCBS OF IOWA
IA
01
—
D01791
BCBS OF NEBRASKA
NE
01
—
P00106867
RR MEDICARE PALMETO GPA
—
Enumeration date
07/07/2005
Last updated
11/02/2007
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