Provider Demographics
NPI:1437269800
Name:IREDELL SURGICAL ASSOCIATES, LLP
Entity Type:Organization
Organization Name:IREDELL SURGICAL ASSOCIATES, LLP
Other - Org Name:IREDELL SURGICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:ELKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-448-1022
Mailing Address - Street 1:1720 DAVIE AVE
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28677-3522
Mailing Address - Country:US
Mailing Address - Phone:704-871-0081
Mailing Address - Fax:704-871-0086
Practice Address - Street 1:1720 DAVIE AVE
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-3522
Practice Address - Country:US
Practice Address - Phone:704-871-0081
Practice Address - Fax:704-871-0086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC00650OtherAMB SURG CTR BC/BS #
NC3409866Medicaid
NC00650OtherAMB SURG CTR BC/BS #