Organization
WEST PALM BEACH FL ENDOSCOPY ASC LLC
Active
Other names
Center for Gastrointestinal Endoscopy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PHILLIP A CLENDENIN (PRESIDENT OF LLC)
(615) 665-1283
Entity
Organization
Contact information
Practice address
1117 N OLIVE AVE, SUITE 201, WEST PALM BEACH, FL 33401-3520
(561) 514-0353
(561) 514-0236
Mailing address
1117 N OLIVE AVE, SUITE 201, WEST PALM BEACH, FL 33401-3520
(561) 514-0353
(561) 514-0236
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
1119
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
076072200
—
FL
01
—
P00289060
RAILROAD MEDICARE
FL
Enumeration date
02/17/2006
Last updated
09/07/2023
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