Healthcare Provider Details

I. General information

NPI: 1821510579
Provider Name (Legal Business Name): NOVANT HEALTH BRUNSWICK ENDOSCOPY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2017
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 MEDICAL CAMPUS DR SUITE 101
SUPPLY NC
28462
US

IV. Provider business mailing address

PO BOX 603686
CHARLOTTE NC
28260-3686
US

V. Phone/Fax

Practice location:
  • Phone: 910-721-4300
  • Fax: 910-721-4309
Mailing address:
  • Phone: 336-277-8757
  • Fax: 336-718-8916

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: HEATHER MARIE KING
Title or Position: PRESIDENT & COO NHBMC
Credential:
Phone: 336-726-3316