# FAYETTEVILLE GASTROENTEROLOGY ENDOSCOPY CENTER, LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

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

## Provider details

- **NPI number:** 1962869446
- **Authorized official:** WILLIAM F VORDER BRUEGGE M.D, (OWNER)
- **Authorized official phone:** (910) 323-5203

## Contact information

- **Practice address:** 2041 VALLEYGATE DR, FAYETTEVILLE, NC 28304-3745
- **Practice address phone:** (910) 323-5203
- **Practice address fax:** (910) 323-3650
- **Mailing address:** 2041 VALLEYGATE DR, FAYETTEVILLE, NC 28304-3745
- **Mailing address phone:** (910) 323-5203
- **Mailing address fax:** (910) 323-3650

## Taxonomy

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

## Other

- **Enumeration date:** 01/28/2016
- **Last updated:** 04/14/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | Q591940001 | MEDICARE | NC |