Provider Demographics
NPI:1447324132
Name:ENDOCENTER, LLC
Entity type:Organization
Organization Name:ENDOCENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HAZEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAUEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-871-1721
Mailing Address - Street 1:PO BOX 848816
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02284-8816
Mailing Address - Country:US
Mailing Address - Phone:985-809-8068
Mailing Address - Fax:985-893-6908
Practice Address - Street 1:131-A CHEROKEE ROSE LANE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-7195
Practice Address - Country:US
Practice Address - Phone:985-809-8068
Practice Address - Fax:985-809-7172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA88261QE0800X
LA120261QE0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1568490Medicaid
LA490004975OtherMEDICARE RAILROAD
LA1568490Medicaid