# WILMINGTON GASTROENTEROLOGY ENDOSCOPY CENTER, INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1295948339
- **Authorized official:** MR. STEVEN LEE PETERSON JR. MBA (PRACTICE ADMINISTRATOR)
- **Authorized official phone:** (910) 362-1011

## Contact information

- **Practice address:** 5115 OLEANDER DRIVE, WILMINGTON, NC 28403-7018
- **Practice address phone:** (910) 362-1011
- **Practice address fax:** (910) 362-1012
- **Mailing address:** 5115 OLEANDER DRIVE, WILMINGTON, NC 28403-7018
- **Mailing address phone:** (910) 362-1011
- **Mailing address fax:** (910) 362-1012

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | AS0091 | NC | Yes |

## Other

- **Enumeration date:** 05/07/2007
- **Last updated:** 01/09/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | AS0091 | ASC LICENSE NUMBER | NC |