Provider Demographics
NPI:1538242649
Name:SOUTHWESTERN ENDOSCOPY CENTER, LLC
Entity type:Organization
Organization Name:SOUTHWESTERN ENDOSCOPY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:FRASER
Authorized Official - Last Name:STOKES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-437-7677
Mailing Address - Street 1:300 SPRING CREEK LANE
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:UNIONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15401
Mailing Address - Country:US
Mailing Address - Phone:724-439-8906
Mailing Address - Fax:724-437-9386
Practice Address - Street 1:300 SPRING CREEK LANE
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401
Practice Address - Country:US
Practice Address - Phone:724-437-8840
Practice Address - Fax:724-437-9386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA17291501261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1009084860001Medicaid
PAP00080642OtherRR MEDICARE
2087Medicare UPIN
PA074855Medicare ID - Type Unspecified