Healthcare Provider Details

I. General information

NPI: 1134777832
Provider Name (Legal Business Name): PETERS ENDOSCOPY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2019
Last Update Date: 09/03/2021
Certification Date: 09/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1580 SKEET CLUB RD
HIGH POINT NC
27265-9530
US

IV. Provider business mailing address

645 N MAIN ST
HIGH POINT NC
27260-5017
US

V. Phone/Fax

Practice location:
  • Phone: 336-883-0029
  • Fax:
Mailing address:
  • Phone: 336-883-0029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QE0800X
TaxonomyEndoscopy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ELISE CAREY
Title or Position: PRESIDENT
Credential:
Phone: 336-883-0029