NPIMap

Organization Active NPI

Raleigh NC Endoscopy ASC LLC

Doing business as Raleigh Endoscopy Center-Holly Springs

  • Ambulatory Surgical Clinic/Center
  • Holly Springs, NC
National Provider Identifier
1114734506
Registry record updated Feb 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
RALEIGH NC ENDOSCOPY ASC LLC
Doing business as
Raleigh Endoscopy Center-Holly Springs
Practice address
2061 Ralph Stephens Rd
Holly Springs, NC 27540-8881
Phone
(919) 585-4710
Fax
(919) 930-8609
NPI assigned
Dec 18, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 13, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Katherine Renee Judkins
Title
Vice President
Phone
(615) 240-3770

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X Primary

Addresses

Primary practice location

2061 Ralph Stephens Rd
Holly Springs, NC 27540-8881

Mailing address

1A Burton Hills Blvd Ste 300
Attn: L&C Dept
Nashville, TN 37215-6153
Phone (919) 791-2060

Other names 1

  • Raleigh Endoscopy Center-Holly Springs Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20251113004240 NC Part B Supplier - Ambulatory Surgical Center 4789654971 Practice locations: Holly Springs, NC

Ambulatory surgical center certification: CCN 34C0001240

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
Raleigh Endoscopy Center Holly Springs
Certification status
Active
Provider type (POS)
Ambulatory surgical center
Participating since
Jan 28, 2026
Last certification
Jan 13, 2026
Facility address
2061 Ralph Stephens Rd.
Holly Springs, NC 27540

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
34D2320320Raleigh Endoscopy Center Holly Springs2061 Ralph Stephens Rd, Holly Springs, NC 27540Certificate of waiverMar 16, 2027

National Provider Directory

National Provider Directory
Tax ID family
Raleigh Endoscopy Center3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2061 Ralph Stephens Rd
Holly Springs, NC 27540
Phone (919) 585-4710

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1734480000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1770940800000",
    "number": "1114734506",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1A BURTON HILLS BLVD STE 300",
            "address_2": "ATTN: L&C DEPT",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372156153",
            "telephone_number": "919-791-2060",
            "fax_number": "615-234-1720"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2061 RALPH STEPHENS RD",
            "city": "HOLLY SPRINGS",
            "state": "NC",
            "postal_code": "275408881",
            "telephone_number": "919-585-4710",
            "fax_number": "919-930-8609"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RALEIGH NC ENDOSCOPY ASC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-12-18",
        "last_updated": "2026-02-13",
        "certification_date": "2026-02-13",
        "status": "A",
        "authorized_official_last_name": "JUDKINS",
        "authorized_official_first_name": "KATHERINE",
        "authorized_official_middle_name": "RENEE",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "615-240-3770"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Raleigh Endoscopy Center-Holly Springs",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Holly Springs, NC

Sources for this page

Verify at the official NPI Registry.