1730382789 NPI number — ENDOSCOPY CENTER - HUNTERSVILLE, LLC

Table of content: MS. CHERYL ANN OTERMAT MACCCSLP (NPI 1902027550)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730382789 NPI number — ENDOSCOPY CENTER - HUNTERSVILLE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ENDOSCOPY CENTER - HUNTERSVILLE, 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:
1730382789
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 32861
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:
28232-2861
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-512-6438
Provider Business Mailing Address Fax Number:
704-512-8485

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16455 STATESVILLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUNTERSVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28078-7135
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-446-5193
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/07/2007

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)





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