Provider Demographics
NPI:1821510579
Name:NOVANT HEALTH BRUNSWICK ENDOSCOPY CENTER, LLC
Entity Type:Organization
Organization Name:NOVANT HEALTH BRUNSWICK ENDOSCOPY CENTER, LLC
Other - Org Name:NOVANT HEALTH BRUNSWICK ENDOSCOPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & COO NHBMC
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-726-3316
Mailing Address - Street 1:2085 FRONTIS PLAZA BLVD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-5614
Mailing Address - Country:US
Mailing Address - Phone:336-277-7226
Mailing Address - Fax:336-277-9795
Practice Address - Street 1:13 MEDICAL CAMPUS DR
Practice Address - Street 2:SUITE 101
Practice Address - City:SUPPLY
Practice Address - State:NC
Practice Address - Zip Code:28462
Practice Address - Country:US
Practice Address - Phone:910-721-4300
Practice Address - Fax:910-721-4309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-14
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical