Organization
OLD TOWN ENDOSCOPY CENTER LLC
Active
Other names
Old Town Endoscopy Center
Organization subpart
No
Provider details
NPI number
Authorized official
ALINA LOGAN (VICE PRESIDENT)
(615) 240-3740
Entity
Organization
Contact information
Practice address
5500 GREENVILLE AVENUE SUITE 1100, DALLAS, TX 75206
(214) 739-9544
(214) 739-9582
Mailing address
1A BURTON HILLS BLVD. ATTN: PROVIDER ENROLLMENT, NASHVILLE, TN 37215-6187
(615) 922-6102
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
—
—
Other
Enumeration date
02/07/2018
Last updated
02/07/2018
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