Provider Demographics
NPI:1730192014
Name:NOVATO ENDOSCOPY CENTER LLC
Entity type:Organization
Organization Name:NOVATO ENDOSCOPY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:N
Authorized Official - Last Name:MARCUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD PH D
Authorized Official - Phone:650-496-4141
Mailing Address - Street 1:PO BOX 39000
Mailing Address - Street 2:DEPT 33691-02
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94139
Mailing Address - Country:US
Mailing Address - Phone:650-493-7729
Mailing Address - Fax:650-493-7959
Practice Address - Street 1:7595 REDWOOD BLVD
Practice Address - Street 2:SUITE 106
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94945
Practice Address - Country:US
Practice Address - Phone:415-892-3414
Practice Address - Fax:415-892-3499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA110000505261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical