Healthcare Provider Details

I. General information

NPI: 1548343833
Provider Name (Legal Business Name): ENDOSCOPY CENTER OF LAKE NORMAN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 01/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16525 HOLLY CREST LN SUITE 200
HUNTERSVILLE NC
28078-4909
US

IV. Provider business mailing address

PO BOX 3141
HUNTERSVILLE NC
28070-3141
US

V. Phone/Fax

Practice location:
  • Phone: 704-377-4009
  • Fax:
Mailing address:
  • Phone: 704-602-6590
  • Fax: 704-602-6563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0800X
TaxonomyEndoscopy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KATHY SAMMIS
Title or Position: ADMINISTRATOR
Credential:
Phone: 704-602-6545