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Organization
LIVE OAK ENDOSCOPY CENTER, LLC
Active
Organization
LIVE OAK ENDOSCOPY CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILLIAM J MCCORMACK M.D. (C.E.O.)
(772) 299-5005
Entity
Organization
Contact information
Practice address
275 18TH ST, SUITE 101, VERO BEACH, FL 32960-5555
(772) 299-5005
(772) 299-1340
Mailing address
275 18TH ST, SUITE 101, VERO BEACH, FL 32960-5555
(772) 299-5005
(772) 299-1340
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
1154
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
075390400
—
FL
01
—
4677223
CIGNA
—
01
—
490005670
RAILROAD MEDICARE
FL
01
—
6B6
BC BS FLORIDA
FL
01
—
A2882678
OXFORD HEALTH PLAN
—
Enumeration date
09/07/2005
Last updated
06/08/2009
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