Executive Endoscopy, Inc

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

EXECUTIVE ENDOSCOPY, INC

Doing business as

Endoscopy Center of San Jose

Practice address

2100 Forest Ave
109
San Jose, CA 95128-1422

Phone

(408) 297-2314

Fax

(408) 297-2414

NPI assigned

Oct 4, 2005

Organization subpart

No

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

Authorized official

Name

Mrs. Maribel Rivera

Title

Office Manager

Phone

(408) 297-2314

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Endoscopy Center of San Jose Doing business as

Tax ID family

Endoscopy Center of San Jose2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Executive Endoscopy, Inc.

  • Ambulatory Surgical Clinic/Center
  • San Jose, CA
  • NPI 1598815110
  NPD tax ID

Locations

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

{
    "created_epoch": "1128384000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1194712109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 FOREST AVE",
            "address_2": "109",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951281422",
            "telephone_number": "408-297-2314",
            "fax_number": "408-297-2414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 FOREST AVE",
            "address_2": "109",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951281422",
            "telephone_number": "408-297-2314",
            "fax_number": "408-297-2414"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXECUTIVE ENDOSCOPY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-04",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "RIVERA",
        "authorized_official_first_name": "MARIBEL",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "408-297-2314",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SUR01553F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Endoscopy Center of San Jose",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Evon Cadogan MD Inc
• Evonne'S Residential Care Facility
• Tai Ewell
• Excel Medicine Inc
• Excelsior Healthcare, Inc.
• Executive Endoscopy, Inc.
• Tracy Renee Exley, M.D
• Expanding Pathways
• Kassandra Courtney Expose
• Expressone Inc

• Ambulatory Surgical Clinic/Center in San Jose, CA
• Providers in San Jose, CA by specialty
• Ambulatory Surgical Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.