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Organization
E STREET ENDOSCOPY LLC
Active
Organization
E STREET ENDOSCOPY LLC
Active
Other names
WEST COAST ENDOSCOPY
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KIMBERLY JIRAN JR. (CHIEF ADMINITRATIVE OFFICER)
(727) 447-0888
Entity
Organization
Contact information
Practice address
616 E ST, CLEARWATER, FL 33756-3342
(727) 447-0888
(727) 447-0993
Mailing address
616 E ST, CLEARWATER, FL 33756-3342
(727) 447-0888
(727) 447-0993
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
1145
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002689600
—
FL
01
—
106705-01
CITRUS HEALTHCARE
FL
01
—
187028
AMERIGROUP
FL
01
—
1972392
FIRST HEALTH
FL
01
—
209367
WELLCARE
FL
01
—
285376
AVMED
FL
01
—
2894273
AETNA HMO
FL
01
—
490005538
RAILROAD MEDICARE
FL
01
—
6A5
BLUE CROSS BLUE SHIELD
FL
01
—
7337369
AETNA
FL
01
—
9131340001
CIGNA
FL
Enumeration date
05/23/2005
Last updated
04/25/2018
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