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General NPI Number Information
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NPI Number | 1134777832
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Entity Type | Organization
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Legal Business Name | PETERS ENDOSCOPY CENTER, LLC
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Dates
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Enumeration Date | 08/27/2019
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Last Update Date | 09/03/2021
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Provider Practice Location Address
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Address Line | 1580 SKEET CLUB RD
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City | HIGH POINT
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State | NC
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Zip | 27265-9530
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Country | US
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Telephone | 336-883-0029
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Fax |
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Provider Business Mailing Address
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Address Line | 645 N MAIN ST
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City | HIGH POINT
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State | NC
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Zip | 27260-5017
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Country | US
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Telephone | 336-883-0029
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ELISE CAREY
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Credential |
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Telephone | 336-883-0029
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0800X
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Taxonomy Name | Endoscopy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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