Healthcare Provider Details

I. General information

NPI: 1982178042
Provider Name (Legal Business Name): LANGTREE ENDOSCOPY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2019
Last Update Date: 05/19/2025
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 ALEXANDER BANK DRIVE SUITE 101
MOORESVILLE NC
28117
US

IV. Provider business mailing address

106 ALEXANDER BANK DR STE 101
MOORESVILLE NC
28117-9624
US

V. Phone/Fax

Practice location:
  • Phone: 704-660-2651
  • Fax: 704-663-6521
Mailing address:
  • Phone: 704-660-2651
  • Fax: 704-663-6521

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: SCOTT J. MORONEY
Title or Position: PRESIDENT
Credential:
Phone: 704-355-9320