Basic Information
| Provider Information | |||||||||
| NPI: | 1548343833 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ENDOSCOPY CENTER OF LAKE NORMAN, LLC | ||||||||
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| OtherOrganizationName: | PRESBYTERIAN ENDOSCOPY CENTER AT HUNTERSVILLE | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3141 | ||||||||
| Address2: | |||||||||
| City: | HUNTERSVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280703141 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7046026590 | ||||||||
| FaxNumber: | 7046026563 | ||||||||
| Practice Location | |||||||||
| Address1: | 16525 HOLLY CREST LN | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | HUNTERSVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280784909 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7043774009 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/23/2006 | ||||||||
| LastUpdateDate: | 01/11/2013 | ||||||||
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| AuthorizedOfficialLastName: | SAMMIS | ||||||||
| AuthorizedOfficialFirstName: | KATHY | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 7046026545 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QE0800X | Y | Ambulatory Health Care Facilities | Clinic/Center | Endoscopy |
No ID Information.