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General NPI Number Information
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NPI Number | 1225225592
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Entity Type | Organization
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Legal Business Name | WESTERN CAROLINA ENDOSCOPY CENTER, LLC
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Dates
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Enumeration Date | 10/01/2007
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Last Update Date | 05/21/2014
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Provider Practice Location Address
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Address Line | 197 RIVERVIEW ST
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City | FRANKLIN
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State | NC
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Zip | 28734-7335
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Country | US
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Telephone | 828-349-3636
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 111
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City | SYLVA
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State | NC
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Zip | 28779-0111
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Country | US
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Telephone | 828-349-3636
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. PHILLIP STACK
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Credential | MD
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Telephone | 828-349-3636
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | AS0097
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License Number State | NC
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