Kissimmee Endoscopy Center Associates, Inc

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

1130 Issued in FL

Legal business name

KISSIMMEE ENDOSCOPY CENTER ASSOCIATES, INC

Practice address

715 Oak Commons Blvd
Kissimmee, FL 34741-4213

Phone

(407) 463-0672

Fax

(407) 581-2777

NPI assigned

Oct 6, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Shamus M Holt, MBA

Title

Administrator

Phone

(407) 463-0672

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Kissimmee Endoscopy Cen2 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.

• Kissimmee Endoscopy Center

  • Endoscopy Clinic/Center
  • Kissimmee, FL
  • NPI 1477595056
  NPD tax ID

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

{
    "created_epoch": "1160092800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1366539629",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "715 OAK COMMONS BLVD",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347414213",
            "telephone_number": "407-463-0672",
            "fax_number": "407-581-2777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "715 OAK COMMONS BLVD",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347414213",
            "telephone_number": "407-463-0672",
            "fax_number": "407-581-2777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KISSIMMEE ENDOSCOPY CENTER ASSOCIATES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-06",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HOLT",
        "authorized_official_first_name": "SHAMUS",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "407-463-0672",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "FL",
            "license": "1130",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AHCA ASC LICENSE #",
            "identifier": "1130",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kissimmee Assisted Living LLC
• Kissimmee Chiropractic Center and Rehab Inc
• Kissimmee Dental Associates PA
• Kissimmee Diagnostic Center,LLC
• Kissimmee Endoscopy Center
• Kissimmee Facility Operations LLC
• Kissimmee Family Dentistry, PLLC
• Kissimmee FL Opco LLC
• Kissimmee Health Care Associates LLC
• Kissimmee Injury Clinic LLC

• Ambulatory Surgical Clinic/Center in Kissimmee, FL
• Providers in Kissimmee, FL by specialty
• Ambulatory Surgical Clinic/Center in Florida

• 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.