Basic Information
| Provider Information | |||||||||
| NPI: | 1528053311 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AMERICAN ENDOSCOPY CENTER, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1308 BRIARVILLE RD | ||||||||
| Address2: | |||||||||
| City: | MADISON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371155127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6158683131 | ||||||||
| FaxNumber: | 6155150205 | ||||||||
| Practice Location | |||||||||
| Address1: | 1308 BRIARVILLE RD | ||||||||
| Address2: | |||||||||
| City: | MADISON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371155127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6158683131 | ||||||||
| FaxNumber: | 6155150205 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/17/2005 | ||||||||
| LastUpdateDate: | 07/13/2007 | ||||||||
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| AuthorizedOfficialLastName: | ZUA | ||||||||
| AuthorizedOfficialFirstName: | MENE | ||||||||
| AuthorizedOfficialMiddleName: | SUGAGE | ||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 6158683131 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | 160 | TN | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
ID Information
| ID | Type | State | Issuer | Description | 3739615 | 05 | TN | MEDICAID |