Organization
KISSIMMEE ENDOSCOPY CENTER
Active
Organization
KISSIMMEE ENDOSCOPY CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHRISTOPHER A HOLDEN (CHIEF MANGER OF LLC)
(615) 665-1283
Entity
Organization
Contact information
Practice address
715 OAK COMMONS BLVD, KISSIMMEE, FL 34741-4213
(407) 931-2816
(407) 931-3485
Mailing address
715 OAK COMMONS BLVD, KISSIMMEE, FL 34741-4213
(407) 931-2816
(407) 931-3485
Taxonomy
Speciality
Code
Description
License number
State
261QE0800X
Endoscopy Clinic/Center
Primary
1130
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
199240
STAYWELL/WELLCARE
—
01
—
283180
AVMED
—
01
—
6A8
BC/BS
FL
01
—
6A8
HEALTH OPTIONS
—
01
—
7144367
AETNA PPO/POS
—
01
—
AETNA HMO
2802721
—
01
—
AMERIGROUP
113612
—
01
—
CIGNA
6547055
—
Enumeration date
06/11/2006
Last updated
10/02/2007
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