Willow Park Endoscopy Center, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

WILLOW PARK ENDOSCOPY CENTER, LLC

Practice address

130 Jimma Drive
Suite B
Willow Park, TX 76087

Phone

(817) 363-1410

Fax

(817) 363-1411

NPI assigned

Apr 28, 2022

Organization subpart

Yes

Parent organization

GI ALLIANCE SURGERY CENTER, PLLCAs reported in NPPES

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

Authorized official

Name

Kim West, RN

Title

Ceo

Phone

(817) 415-0343

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Listed as

Willow Park Endoscopy Center LLCCCN 45C0451253

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Texas Digestive Disease Consultants PLLC

  • Gastroenterology Physician
  • Covington, LA
  • NPI 1295428415

  Member Of

  NPD member

Locations

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

{
    "created_epoch": "1651104000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1702598400000",
    "number": "1487399168",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 JIMMA DRIVE",
            "address_2": "SUITE B",
            "city": "WILLOW PARK",
            "state": "TX",
            "postal_code": "76087",
            "telephone_number": "817-363-1410",
            "fax_number": "817-363-1411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 JIMMA DRIVE",
            "address_2": "SUITE B",
            "city": "WILLOW PARK",
            "state": "TX",
            "postal_code": "76087",
            "telephone_number": "817-363-1410",
            "fax_number": "817-363-1411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLOW PARK ENDOSCOPY CENTER, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GI ALLIANCE SURGERY CENTER, PLLC",
        "enumeration_date": "2022-04-28",
        "last_updated": "2023-12-15",
        "certification_date": "2022-12-02",
        "status": "A",
        "authorized_official_last_name": "WEST",
        "authorized_official_first_name": "KIM",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "817-415-0343",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sydney Katherine White, BCBA
• Jessica Marie Wight, FNP-C
• Hannah Wilke, DC
• Tina Ann Wilkinson Moore, PA
• Jessica Danielle Williams, DO
• Willow Park Home Health Care Services, Inc.
• Johnny M Wilson, M.D.
• Braden Alexander Wood
• Kayla Wood
• Russell S Wood, PH.D.

• Ambulatory Surgical Clinic/Center in Willow Park, TX
• Providers in Willow Park, TX by specialty
• Ambulatory Surgical Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.