# MARLBORO GASTROENTEROLOGY ASSOCIATES PA

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** MARLBORO GASTROENTEROLOGY ASSOCIATES PA
- **Other names:** MARLBORO GI ENDOSCOPY CENTER
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1609940352
- **Legal business name:** MARLBORO GASTROENTEROLOGY ASSOCIATES PA
- **Authorized official:** MRS. PATRICIA J RIDDLE (ADMINISTRATOR)
- **Authorized official phone:** (843) 479-9794

## Contact information

- **Practice address:** 102 ENDO LN, SUITE 1, HAMLET, NC 28345-4560
- **Practice address phone:** (910) 582-3636
- **Practice address fax:** (910) 205-2251
- **Mailing address:** PO BOX 617, BENNETTSVILLE, SC 29512-0617
- **Mailing address phone:** (843) 479-9794
- **Mailing address fax:** (843) 479-8076

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | AS0083 | NC | Yes |
| 261QE0800X | Endoscopy Clinic/Center | AS0083 | NC | — |

## Other

- **Enumeration date:** 11/17/2006
- **Last updated:** 06/17/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 3409943 | — | NC |
| 01 | — | P00364907 | RR MEDICARE | NC |