1205908456 NPI number — ENDOSCOPY CENTER -PINEVILLE LLC

Table of content: (NPI 1205908456)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205908456 NPI number — ENDOSCOPY CENTER -PINEVILLE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ENDOSCOPY CENTER -PINEVILLE 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:
6
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:
1205908456
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/20/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3426 TORINGDON WAY STE 108
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28277-3497
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-372-7974
Provider Business Mailing Address Fax Number:
704-970-4746

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10520 PARK RD
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28210-8487
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-927-5756
Provider Business Practice Location Address Fax Number:
704-927-5757
Provider Enumeration Date:
11/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ROTHROCK
Authorized Official First Name:
JULIE
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING COORDINATOR
Authorized Official Telephone Number:
704-372-7974

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2381097A . This is a "MEDICARE, OTHER" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com