# VIDANT MEDICAL GROUP LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** VIDANT MEDICAL GROUP LLC
- **Other names:** Vidant Endoscopy Center-Kinston
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1376049619
- **Legal business name:** VIDANT MEDICAL GROUP LLC
- **Authorized official:** MR. ANTHONY WAYNE BARHOLOMEW (VP, OPERACTIONS)
- **Authorized official phone:** (252) 847-9067

## Contact information

- **Practice address:** 701 DOCTORS DR STE N, KINSTON, NC 28501-1584
- **Practice address phone:** (252) 559-2200
- **Practice address fax:** (252) 522-5662
- **Mailing address:** PO BOX 8423, GREENVILLE, NC 27835-8423
- **Mailing address phone:** (252) 847-9067
- **Mailing address fax:** (252) 847-7091

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | AS0122 | NC | Yes |

## Other

- **Enumeration date:** 04/04/2018
- **Last updated:** 04/04/2018