Provider Demographics
NPI:1437623626
Name:PRIME SURGICAL SUITES, LLC
Entity Type:Organization
Organization Name:PRIME SURGICAL SUITES, LLC
Other - Org Name:SCSV, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:VP, CFO
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SHADOWENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-757-5100
Mailing Address - Street 1:321 MULBERRY ST SW
Mailing Address - Street 2:
Mailing Address - City:LENOIR
Mailing Address - State:NC
Mailing Address - Zip Code:28645-5720
Mailing Address - Country:US
Mailing Address - Phone:828-757-5100
Mailing Address - Fax:
Practice Address - Street 1:180 RIVERBEND DR
Practice Address - Street 2:
Practice Address - City:GRANITE FALLS
Practice Address - State:NC
Practice Address - Zip Code:28630
Practice Address - Country:US
Practice Address - Phone:828-757-5100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-22
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical