Provider Demographics
NPI:1598942716
Name:SURGERY CENTER OF WILSON, LLC
Entity Type:Organization
Organization Name:SURGERY CENTER OF WILSON, LLC
Other - Org Name:SURGECENTER OF WILSON
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:SYNDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-237-5649
Mailing Address - Street 1:1709 MEDICAL PARK DR W
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-2788
Mailing Address - Country:US
Mailing Address - Phone:252-237-5649
Mailing Address - Fax:252-237-4977
Practice Address - Street 1:1709 MEDICAL PARK DR W
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-2788
Practice Address - Country:US
Practice Address - Phone:252-237-5649
Practice Address - Fax:252-237-4977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-30
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical