Healthcare Provider Details

I. General information

NPI: 1730382789
Provider Name (Legal Business Name): ENDOSCOPY CENTER - HUNTERSVILLE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2007
Last Update Date: 02/07/2023
Certification Date: 02/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16455 STATESVILLE RD
HUNTERSVILLE NC
28078-7135
US

IV. Provider business mailing address

PO BOX 32861
CHARLOTTE NC
28232-2861
US

V. Phone/Fax

Practice location:
  • Phone: 704-446-5193
  • Fax:
Mailing address:
  • Phone: 704-512-6438
  • Fax: 704-512-8485

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: JULIE ROTHROCK
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 704-372-7974