Provider Demographics
NPI:1124594338
Name:CHARLOTTE SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:CHARLOTTE SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF ADMINISTRATIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:LALLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-377-1647
Mailing Address - Street 1:3621 RANDOLPH RD STE 200
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-0027
Mailing Address - Country:US
Mailing Address - Phone:704-377-1647
Mailing Address - Fax:
Practice Address - Street 1:3621 RANDOLPH RD STE 200
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-0027
Practice Address - Country:US
Practice Address - Phone:704-377-1647
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHARLOTTE SURGERY CENTER, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-10-16
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical