1912340944 NPI number — DIGESTIVE HEALTH ENDOSCOPY CENTER, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912340944 NPI number — DIGESTIVE HEALTH ENDOSCOPY CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIGESTIVE HEALTH ENDOSCOPY CENTER, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912340944
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/30/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 87388
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAYETTEVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28304-7388
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-323-2477
Provider Business Mailing Address Fax Number:
910-323-1913

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3202 BOONE TRL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAYETTEVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28306
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-323-2477
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/09/2013

Additional Information

Authorized Official

Authorized Official Last Name:
ELLIOTT
Authorized Official First Name:
MITTIE
Authorized Official Middle Name:
CANADY
Authorized Official Title or Position:
OPERATIONS MANAGER
Authorized Official Telephone Number:
910-323-2477

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  ASO123 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QE0800X , with the licence number: ASO123 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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