Provider Demographics
NPI:1003860917
Name:SURGERY CENTER OF PINEHURST, LLC
Entity Type:Organization
Organization Name:SURGERY CENTER OF PINEHURST, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:NICK
Authorized Official - Middle Name:
Authorized Official - Last Name:CRANSTON
Authorized Official - Suffix:
Authorized Official - Credentials:MHA, BSN, RN, CNOR
Authorized Official - Phone:910-235-5010
Mailing Address - Street 1:PO BOX 63194
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28263-3194
Mailing Address - Country:US
Mailing Address - Phone:910-235-5000
Mailing Address - Fax:910-295-5739
Practice Address - Street 1:10 FIRST VILLAGE DRIVE
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374
Practice Address - Country:US
Practice Address - Phone:910-235-5000
Practice Address - Fax:910-295-5739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC34C0001114261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
611152900OtherUS DEPT OF LABOR
NC3409939Medicaid
NC0061TOtherBLUE CROSS BLUE SHIELD
NC3409939Medicaid
P00301552OtherRAILROAD MEDICARE
P00301552OtherRAILROAD MEDICARE