MEDICARE: PARK ENDOSCOPY CENTER, 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
1	261QA1903X	Ambulatory Surgical Clinic/Center	AS0121	NC

General Provider Information

NPI Number	:	1417193939
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARK ENDOSCOPY CENTER, LLC

Provider Business Mailing Address
First Line	:	2602 NORTH HERRITAGE STREET
Second Line	:
City	:	KINSTON
State	:	NC
Zip	:	28501-1503
Country	:	US
Telephone Number	:	252-527-6565
Fax Number	:	252-233-0573

Provider Business Practice Location Address
First Line	:	2602 NORTH HERRITAGE STREET
Second Line	:
City	:	KINSTON
State	:	NC
Zip	:	28501-1503
Country	:	US
Telephone Number	:	252-527-6565
Fax Number	:	252-233-0573

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	JOSEPH A. SARACINO
Credential	:	M.D.
Telephone Number	:	252-527-6565

Provider Enumeration Date	:	01/06/2009
Last Update Date	:	07/22/2016

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