Basic Information
| Provider Information | |||||||||
| NPI: | 1417193939 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PARK ENDOSCOPY CENTER, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2602 NORTH HERRITAGE STREET | ||||||||
| Address2: | |||||||||
| City: | KINSTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 285011503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2525276565 | ||||||||
| FaxNumber: | 2522330573 | ||||||||
| Practice Location | |||||||||
| Address1: | 2602 NORTH HERRITAGE STREET | ||||||||
| Address2: | |||||||||
| City: | KINSTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 285011503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2525276565 | ||||||||
| FaxNumber: | 2522330573 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/06/2009 | ||||||||
| LastUpdateDate: | 07/22/2016 | ||||||||
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| AuthorizedOfficialLastName: | SARACINO | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
| AuthorizedOfficialMiddleName: | A. | ||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 2525276565 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | AS0121 | NC | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.