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General NPI Number Information
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NPI Number | 1497084982
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Entity Type | Organization
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Legal Business Name | WAKE ENDOSCOPY CENTER, LLC
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Dates
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Enumeration Date | 12/14/2009
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Last Update Date | 04/10/2024
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Provider Practice Location Address
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Address Line | 2601 LAKE DR SUITE 201
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City | RALEIGH
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State | NC
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Zip | 27607-6688
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Country | US
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Telephone | 919-783-4888
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Fax | 919-783-4887
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Provider Business Mailing Address
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Address Line | 2601 LAKE DR SUITE 201
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City | RALEIGH
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State | NC
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Zip | 27607-6688
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Country | US
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Telephone | 919-783-4888
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Fax | 919-783-4887
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | WILLIAM CHANCE
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Credential |
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Telephone | 919-783-4888
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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 | ASO111
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License Number State | NC
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