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Organization

FAYETTEVILLE GASTROENTEROLOGY ASSOCIATES, P.A.

Active
Parent organization
FAYETTEVILLE GASTROENTEROLOGY ASSOCIATES, P.A.
Other names
Fayetteville Endoscopy
Organization subpart
Yes

Provider details

NPI number
Legal business name
FAYETTEVILLE GASTROENTEROLOGY ASSOCIATES, P.A.
Authorized official
MRS. TINA M. CASILLO (PRACTICE ADMINISTRATOR)
(910) 323-5203
Entity
Organization

Contact information

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

Taxonomy

Speciality
Code
Description
License number
State
261QE0800X
Endoscopy Clinic/Center
Primary
AS0071
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
2380979
MEDICARE FACILITY NUMBER
NC
Enumeration date
08/30/2007
Last updated
02/11/2021
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