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General NPI Number Information
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NPI Number | 1285509620
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Entity Type | Organization
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Legal Business Name | MOOREFIELD PARK ENDOSCOPY CENTER, LLC
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Dates
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Enumeration Date | 10/07/2025
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Last Update Date | 10/07/2025
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Provider Practice Location Address
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Address Line | 800 MOOREFIELD PARK DR STE 100
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City | NORTH CHESTERFIELD
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State | VA
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Zip | 23236-3686
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Country | US
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Telephone | 817-893-2381
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Fax |
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Provider Business Mailing Address
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Address Line | 550 RESERVE ST STE 550
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City | SOUTHLAKE
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State | TX
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Zip | 76092-1604
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Country | US
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Telephone | 817-893-2381
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Fax |
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Authorized Official
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Title or Position | SR. DIRECTOR OF ASC COMPLIANCE
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Name | KELLY ROUVALDT
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Credential |
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Telephone | 817-893-2381
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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 |
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License Number State |
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