Stockton Endoscopy Center LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

30000792 Issued in CA

Legal business name

STOCKTON ENDOSCOPY CENTER LLC

Practice address

415 E Harding Way
Suite E
Stockton, CA 95204

Phone

(209) 942-1179

Fax

(209) 942-2200

NPI assigned

Aug 15, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Samuel N Marcus, MD PHD

Title

Co Founder

Phone

(650) 496-4141

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1155600000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1386657666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 39000",
            "address_2": "DEPT 33691 09",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "94139",
            "telephone_number": "650-493-7729",
            "fax_number": "650-493-7959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 E HARDING WAY",
            "address_2": "SUITE E",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "95204",
            "telephone_number": "209-942-1179",
            "fax_number": "209-942-2200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STOCKTON ENDOSCOPY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-15",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MARCUS",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "CO FOUNDER",
        "authorized_official_telephone_number": "650-496-4141",
        "authorized_official_credential": "MD PHD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "CA",
            "license": "30000792",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Ambulatory Surgical Clinic/Center in Stockton, CA
• Providers in Stockton, 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.