Organization
MEDICAL CENTER ENDOSCOPY, LLC
Active
Other names
MEDICAL CENTER ENDOSCOPY
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER BOYD BALDOCK (OFFICER AND AUTHORIZED OFFICIAL)
(615) 234-5954
Entity
Organization
Contact information
Practice address
6560 FANNIN ST, SUITE 600, HOUSTON, TX 77030-2761
(713) 796-0500
(713) 797-1417
Mailing address
6560 FANNIN ST, SUITE 600, HOUSTON, TX 77030-2761
(713) 796-0500
(713) 797-1417
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
0399
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
45C0001238
MEDICARE PROVIDER #
TX
01
—
ASC025
MEDICARE PTAN
TX
Enumeration date
08/13/2006
Last updated
11/10/2022
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