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General NPI Number Information
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NPI Number | 1548343833
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Entity Type | Organization
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Legal Business Name | ENDOSCOPY CENTER OF LAKE NORMAN, LLC
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Dates
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Enumeration Date | 10/23/2006
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Last Update Date | 01/11/2013
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Provider Practice Location Address
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Address Line | 16525 HOLLY CREST LN SUITE 200
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City | HUNTERSVILLE
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State | NC
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Zip | 28078-4909
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Country | US
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Telephone | 704-377-4009
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3141
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City | HUNTERSVILLE
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State | NC
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Zip | 28070-3141
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Country | US
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Telephone | 704-602-6590
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Fax | 704-602-6563
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | KATHY SAMMIS
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Credential |
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Telephone | 704-602-6545
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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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