Provider Demographics
NPI:1508041666
Name:MOYE MEDICAL ENDOSCOPY CENTER LLC
Entity Type:Organization
Organization Name:MOYE MEDICAL ENDOSCOPY CENTER LLC
Other - Org Name:EAST CAROLINA ENDOSCOPY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF CANCER & CLINICAL SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:HICKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-847-7836
Mailing Address - Street 1:2100 STANTONSBURG RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-2818
Mailing Address - Country:US
Mailing Address - Phone:252-847-7479
Mailing Address - Fax:252-847-6372
Practice Address - Street 1:521-C MOYE BLVD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-2849
Practice Address - Country:US
Practice Address - Phone:252-744-8400
Practice Address - Fax:252-744-6601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3409977Medicaid
NC0063KOtherBCBS
NC3409977Medicaid