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Organization

MARLBORO GASTROENTEROLOGY ASSOCIATES PA

Active
Parent organization
MARLBORO GASTROENTEROLOGY ASSOCIATES PA
Other names
MARLBORO GI ENDOSCOPY CENTER
Organization subpart
Yes

Provider details

NPI number
Legal business name
MARLBORO GASTROENTEROLOGY ASSOCIATES PA
Authorized official
MRS. PATRICIA J RIDDLE (ADMINISTRATOR)
(843) 479-9794
Entity
Organization

Contact information

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

Taxonomy

Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
AS0083
NC
261QE0800X
Endoscopy Clinic/Center
AS0083
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
3409943
NC
01
P00364907
RR MEDICARE
NC
Enumeration date
11/17/2006
Last updated
06/17/2008
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