Marlboro Gastroenterology Associates PA

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

AS0083 Issued in NC

Legal business name

MARLBORO GASTROENTEROLOGY ASSOCIATES PA

Practice address

102 Endo LN
Suite 1
Hamlet, NC 28345-4560

Phone

(910) 582-3636

Fax

(910) 205-2251

NPI assigned

Nov 17, 2006

Last updated

Jun 17, 2008By the provider in NPPES

Organization subpart

Yes

Parent organization

MARLBORO GASTROENTEROLOGY ASSOCIATES PAAs reported in NPPES

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

Authorized official

Name

Mrs. Patricia J Riddle

Title

Administrator

Phone

(843) 479-9794

Specialties & licenses 2

Addresses

Other names 1

• MARLBORO GI ENDOSCOPY CENTER Other name

Part of

Marlboro Gastroenterolo

Locations

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Marlboro Gastroenterology Associates PA

  • Gastroenterology Physician
  • Hamlet, NC
  • NPI 1922077403
  NPPES parent name

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

{
    "created_epoch": "1163721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213660800000",
    "number": "1609940352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 617",
            "city": "BENNETTSVILLE",
            "state": "SC",
            "postal_code": "295120617",
            "telephone_number": "843-479-9794",
            "fax_number": "843-479-8076"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 ENDO LN",
            "address_2": "SUITE 1",
            "city": "HAMLET",
            "state": "NC",
            "postal_code": "283454560",
            "telephone_number": "910-582-3636",
            "fax_number": "910-205-2251"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARLBORO GASTROENTEROLOGY ASSOCIATES PA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MARLBORO GASTROENTEROLOGY ASSOCIATES PA",
        "enumeration_date": "2006-11-17",
        "last_updated": "2008-06-17",
        "status": "A",
        "authorized_official_last_name": "RIDDLE",
        "authorized_official_first_name": "PATRICIA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "843-479-9794",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "NC",
            "license": "AS0083",
            "primary": true
        },
        {
            "code": "261QE0800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Endoscopy",
            "state": "NC",
            "license": "AS0083",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MARLBORO GI ENDOSCOPY CENTER",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Katherine Elizabeth Luebke, CRNA
• Hector Luis Luna, PA-C
• Laura Marie Macri
• Siddharth Ved Malhotra, M.D.
• Charlita Mangrum, MD
• Marlboro Gastroenterology Associates PA
• Pam Marsh, COF
• Harold L Martin, MD
• Jennie Davis Maultsby, OTR/L
• Monteeia Shanta McDonald

• Ambulatory Surgical Clinic/Center in Hamlet, NC
• Providers in Hamlet, NC by specialty
• Ambulatory Surgical Clinic/Center in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.