FAYETTEVILLE GASTROENTEROLOGY ENDOSCOPY CENTER, LLC – NPI #1962869446
Clinic/Center

FAYETTEVILLE GASTROENTEROLOGY ENDOSCOPY CENTER, LLC is an AHC clinic located in FAYETTEVILLE, NC. NPPES has assigned the NPI number 1962869446 to FAYETTEVILLE GASTROENTEROLOGY ENDOSCOPY CENTER, LLC on January 28, 2016. 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 previously updated about 5 years ago on Apr 14, 2021. 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 FAYETTEVILLE GASTROENTEROLOGY ENDOSCOPY CENTER, LLC below.

NPI Profile for
FAYETTEVILLE GASTROENTEROLOGY ENDOSCOPY CENTER, LLC

NPI Number
1962869446
Enumeration Date

(more than 10 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
FAYETTEVILLE GASTROENTEROLOGY ENDOSCOPY CENTER, LLC
Primary location
2041 VALLEYGATE DR
FAYETTEVILLE, NC 28304-3745
Phone: (910) 323-5203 Fax: (910) 323-3650
Mailing address
Same as primary location
Organization Subpart
No
Authorized Official
WILLIAM VORDER BRUEGGE
OWNER
Phone: (910) 323-5203
Updated
Certification Date
Apr 14, 2021

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.

Identifiers

Identifiers for FAYETTEVILLE GASTROENTEROLOGY ENDOSCOPY CENTER, LLC

Identifiers are used to associate other provider identifiers such as Medicaid or other insurers (ie:, Blue Cross, Blue Shield, Aetna, Kaiser-Permanente, etc.), with their NPI number. These identifiers can be used in matching an NPI number to an insurer's records. However, not all providers have such numbers and not all providers choose to include them in their NPI information.

DescriptionIssuerStateIdentifier
OTHERMEDICARENCQ591940001
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)		 NC

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.