Healthcare Provider Details

I. General information

NPI: 1861996712
Provider Name (Legal Business Name): ENDOSCOPY CENTER OF GOLDSBORO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2018
Last Update Date: 03/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2705 MEDICAL OFFICE PL
GOLDSBORO NC
27534-9458
US

IV. Provider business mailing address

401 COMMERCE ST STE 600
NASHVILLE TN
37219-2518
US

V. Phone/Fax

Practice location:
  • Phone: 919-580-9111
  • Fax: 919-580-0988
Mailing address:
  • Phone: 615-345-6695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DALE W POLLEY JR.
Title or Position: PRESIDENT
Credential:
Phone: 615-345-6695