Organization
HALIFAX GASTROENTEROLOGY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. PADMA DEVI YERRA (OFF MANAGER)
(252) 535-6478
Entity
Organization
Contact information
Practice address
1007 GREGORY DR, ROANOKE RAPIDS, NC 27870-6451
(252) 535-6478
(252) 535-6483
Mailing address
1007 GREGORY DR, ROANOKE RAPIDS, NC 27870-6451
(252) 535-6478
(252) 535-6483
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
9700163
NC
261QA1903X
Ambulatory Surgical Clinic/Center
AS0141
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0167J
BCBS
NC
05
—
891068E
—
NC
Enumeration date
08/05/2006
Last updated
02/04/2014
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