SOUTHERN GASTROENTEROLOGY ENDOSCOPY CENTER, P.C. – NPI #1265137517
Clinic/Center

SOUTHERN GASTROENTEROLOGY ENDOSCOPY CENTER, P.C. is an AHC clinic located in SOUTH BOSTON, VA. NPPES has assigned the NPI number 1265137517 to SOUTHERN GASTROENTEROLOGY ENDOSCOPY CENTER, P.C. on April 04, 2023. It is a Type-2 NPI, indicating this NPI number is associated with an organization. The primary taxonomy selected by this provider is 261QA1903X from the Health Care Provider Taxonomy code set, which is classified as Clinic/Center, specializing in Ambulatory Surgical

The NPI profile was last updated on Aug 06, 2025. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for SOUTHERN GASTROENTEROLOGY ENDOSCOPY CENTER, P.C. below.

NPI Profile for
SOUTHERN GASTROENTEROLOGY ENDOSCOPY CENTER, P.C.

NPI Number
1265137517
Enumeration Date

(more than 3 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
SOUTHERN GASTROENTEROLOGY ENDOSCOPY CENTER, P.C.
Primary location
149 AUBREY'S LOOP
SOUTH BOSTON, VA 24592
Phone: (434) 572-8196 Fax: (434) 572-8341
Mailing address
149 AUBREYS LOOP
SOUTH BOSTON, VA 24592-5056
Phone: (434) 572-2810 Fax: (434) 255-0018
Organization Subpart
No
Authorized Official
SUSAN LUEDTKE
PRACTICE MANAGER
Phone: (434) 572-8196
Updated
Certification Date
Aug 06, 2025

Note: NPPES allows providers to attest to the accuracy of their NPI data. When a provider request any change to the NPI record, they will be able to attest to their changed NPI data, resulting in an updated certification date.

Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
261QA1903X
- Clinic/Center / Ambulatory Surgical (Primary)

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.