NORTHEAST ENDOSCOPY CENTER LLC NPI 1578531208

NPI Information

  • NPI: 1578531208
  • Provider Name: NORTHEAST ENDOSCOPY CENTER, LLC
  • Classification: Clinic/Center - 261QA1903X
  • Specialization: Ambulatory Surgical
  • Entity Type: Organization
  • CLIA Number: 11D1048945
  • Address: 721 WELLNESS WAY
    STE 110
    LAWRENCEVILLE, GA
    ZIP 30046
  • Phone: (678) 879-0999

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NPI Details

NORTHEAST ENDOSCOPY CENTER, LLC is an ambulatory surgical clinic center in Lawrenceville, GA. NORTHEAST ENDOSCOPY CENTER, LLC NPI is 1578531208. The provider is registered as an organization entity type.

The provider's business location address is:

721 WELLNESS WAY
STE 110
LAWRENCEVILLE, GA
ZIP 30046-304
Phone: (678) 879-0999
Fax: (678) 578-6873

The provider's authorized official is William Gordon Tanner .
The authorized official title is Director and has the following contact phone number (678) 879-0999.

The CLIA number assigned to this NPI record is 11D1048945 - ambulatory surgery center with a certificate type of Certificate of Waiver.

The following top HCPCS codes were publicly reported for this provider under the Medicare program for the year 2016. The reported codes are based on the top codes for each available Medicare specialty, excluding evaluation and management codes.

  • Biopsy of esophagus, stomach, and/or upper small bowel using a flexible endoscope (HCPCS:43239)
  • Removal of polyps or growths of large bowel using an endoscope with mechanical snare (HCPCS:45385)
  • Biopsy of large bowel using a flexible endoscope (HCPCS:45380)
  • Colorectal cancer screening; colonoscopy on individual at high risk (HCPCS:G0105)
  • Dilation of esophagus (HCPCS:43450)
  • Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk (HCPCS:G0121)
  • Diagnostic exam of large bowel using a flexible endoscope (HCPCS:45378)
  • Insertion of guide wire with dilation of esophagus using a flexible endoscope (HCPCS:43248)
  • Diagnostic exam of esophagus, stomach, and/or upper small bowel using a flexible endoscope (HCPCS:43235)

The enumeration date for this NPI number is 3/9/2006 and was last updated on 8/7/2014.

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
1261QA1903XClinic/CenterAmbulatory Surgical067329GEORGIAYes

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
1111276ASCAMEDICARE ID-TYPE UNSPECIFIEDGEORGIA

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: 11/21/2025

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