Organization
HAZELWOOD ENDOSCOPY CENTER, LLC
Active
Other names
Endoscopy & Colonscopy Center
Organization subpart
No
Provider details
NPI number
Authorized official
JENETHA D MORAN (OFFICER / AUTHORIZED OFFICIAL)
(972) 763-3893
Entity
Organization
Contact information
Practice address
15305 DALLAS PKWY, #1600, ADDISON, TX 75001-4637
(972) 763-3893
(972) 692-6745
Mailing address
100 VILLAGE SQ, HAZELWOOD, MO 63042-1820
(314) 373-8931
(314) 373-8935
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Enumeration date
09/02/2014
Last updated
09/02/2014
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