CHARLOTTE GASTROENTEROLOGY & HEPATOLOGY PLLC NPI 1619124401

NPI Information

NPI: 1619124401
Provider Name: CHARLOTTE GASTROENTEROLOGY & HEPATOLOGY, PLLC
Classification: Clinic/Center - 261QA1903X
Entity Type: Organization

Specialization: Ambulatory Surgical

CLIA Number: 34D2144122

Address:
15830 BALLANTYNE MEDICAL PLACE
SUITE 175
CHARLOTTE, NC
ZIP 28277
Phone: (704) 377-4009
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CHARLOTTE GASTROENTEROLOGY & HEPATOLOGY, PLLC is an ambulatory surgical clinic center in Charlotte, NC. CHARLOTTE GASTROENTEROLOGY & HEPATOLOGY, PLLC NPI is 1619124401. The provider is registered as an organization entity type.

The provider's business location address is:

15830 BALLANTYNE MEDICAL PLACE
SUITE 175
CHARLOTTE, NC
ZIP 28277-295
Phone: (704) 377-4009
Fax: (704) 375-6970

The provider's authorized official is Kathy J. Sammis .
The authorized official title is Chief Executive Offi and has the following contact phone number (704) 717-5549.

The CLIA number assigned to this NPI record is 34D2144122 - physician office with a certificate type of Certificate of Compliance.

The enumeration date for this NPI number is 8/22/2008 and was last updated on 7/13/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QA1903X	Clinic/Center	Ambulatory Surgical	34C001149	NORTH CAROLINA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	3409963	MEDICAID	NORTH CAROLINA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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