NPIMap

Organization Active NPI

Tifton Endoscopy Center, Inc.

  • Ambulatory Surgical Clinic/Center
  • Tifton, GA
National Provider Identifier
1063512945
Registry record updated Jul 16, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
111094ASCA Issued in GA
Legal business name
TIFTON ENDOSCOPY CENTER, INC.
Practice address
1111 20TH St E
Tifton, GA 31794-3689
Phone
(229) 382-9338
Fax
(229) 382-4282
NPI assigned
Sep 22, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Elaine Cleghorn
Title
Business Administrator
Phone
(229) 382-9338

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X 111094ASCA GA Primary

Addresses

Primary practice location

1111 20TH St E
Tifton, GA 31794-3689

Mailing address

1111 20TH St E
Tifton, GA 31794-3689
Phone (229) 382-9338

Other identifiers 1

IdentifierTypeStateIssuer
00755675AMedicaidGA

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Tifton Endoscopy Center IncCCN 11C0001094
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158883200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1563235200000",
    "number": "1063512945",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 20TH ST E",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "317943689",
            "telephone_number": "229-382-9338",
            "fax_number": "229-382-4282"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 20TH ST E",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "317943689",
            "telephone_number": "229-382-9338",
            "fax_number": "229-382-4282"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIFTON ENDOSCOPY CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-22",
        "last_updated": "2019-07-16",
        "status": "A",
        "authorized_official_last_name": "CLEGHORN",
        "authorized_official_first_name": "ELAINE",
        "authorized_official_title_or_position": "BUSINESS ADMINISTRATOR",
        "authorized_official_telephone_number": "229-382-9338"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "GA",
            "license": "111094ASCA",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00755675A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tifton, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.