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NPI Code Detail

MEDICARE: RALEIGH NC ENDOSCOPY ASC LLC

MEDICARE: RALEIGH NC ENDOSCOPY ASC LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QA1903XAmbulatory Surgical Clinic/Center

General Provider Information

NPI Number : 1114734506
Entity Type Code : Organization
Provider Name (Legal Business Name) : RALEIGH NC ENDOSCOPY ASC LLC
Provider Business Mailing Address
First Line : 1A BURTON HILLS BLVD STE 300
Second Line : ATTN: L&C DEPT
City : NASHVILLE
State : TN
Zip : 37215-6153
Country : US
Telephone Number : 919-791-2060
Fax Number : 615-234-1720
Provider Business Practice Location Address
First Line : 2061 RALPH STEPHENS RD
Second Line :
City : HOLLY SPRINGS
State : NC
Zip : 27540-8881
Country : US
Telephone Number : 919-791-2060
Fax Number :
Authorized Official
Title or Position : VICE PRESIDENT
Name : KATHERINE RENEE JUDKINS
Credential :
Telephone Number : 615-240-3770
Provider Enumeration Date : 12/18/2024
Last Update Date : 12/18/2024

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