Provider Demographics
NPI:1225225592
Name:WESTERN CAROLINA ENDOSCOPY CENTER, LLC
Entity Type:Organization
Organization Name:WESTERN CAROLINA ENDOSCOPY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:
Authorized Official - Last Name:STACK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-349-3636
Mailing Address - Street 1:PO BOX 111
Mailing Address - Street 2:
Mailing Address - City:SYLVA
Mailing Address - State:NC
Mailing Address - Zip Code:28779-0111
Mailing Address - Country:US
Mailing Address - Phone:828-349-3636
Mailing Address - Fax:
Practice Address - Street 1:197 RIVERVIEW ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:NC
Practice Address - Zip Code:28734-7335
Practice Address - Country:US
Practice Address - Phone:828-349-3636
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WESTERN CAROLINA DIGESTIVE CONSULTANTS, P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-01
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCAS0097261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2380018Medicare PIN