Provider Demographics
NPI:1356334759
Name:NORTH SHORE ENDOSCOPY CENTER, LLC
Entity type:Organization
Organization Name:NORTH SHORE ENDOSCOPY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LAPORTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-359-8975
Mailing Address - Street 1:1307 FEDERAL ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15212-4705
Mailing Address - Country:US
Mailing Address - Phone:412-231-6550
Mailing Address - Fax:412-231-6697
Practice Address - Street 1:1307 FEDERAL ST
Practice Address - Street 2:SUITE 101
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212-4705
Practice Address - Country:US
Practice Address - Phone:412-231-6550
Practice Address - Fax:412-231-6697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA15901501261QE0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA064522Medicare ID - Type Unspecified