Provider Demographics
NPI:1548963887
Name:PEPPER ROAD ENDOSCOPY CENTER LLC
Entity type:Organization
Organization Name:PEPPER ROAD ENDOSCOPY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MANISH
Authorized Official - Middle Name:B
Authorized Official - Last Name:BHUVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-382-0679
Mailing Address - Street 1:22285 N PEPPER RD.
Mailing Address - Street 2:SUITE 312
Mailing Address - City:LAKE BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010
Mailing Address - Country:US
Mailing Address - Phone:847-382-0679
Mailing Address - Fax:224-655-2270
Practice Address - Street 1:22285 N PEPPER RD.
Practice Address - Street 2:SUITE 312
Practice Address - City:LAKE BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010
Practice Address - Country:US
Practice Address - Phone:847-382-0679
Practice Address - Fax:224-655-2270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-24
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical