Provider Demographics
NPI:1942334065
Name:ATLANTIC SURGICENTER, LLC
Entity Type:Organization
Organization Name:ATLANTIC SURGICENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN OF THE BOARD
Authorized Official - Prefix:DR
Authorized Official - First Name:HORMOZE
Authorized Official - Middle Name:A
Authorized Official - Last Name:GOUDARZI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-763-6571
Mailing Address - Street 1:9104 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28411-7994
Mailing Address - Country:US
Mailing Address - Phone:910-686-2840
Mailing Address - Fax:910-762-6364
Practice Address - Street 1:9104 MARKET ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28411-7994
Practice Address - Country:US
Practice Address - Phone:910-686-2840
Practice Address - Fax:910-762-6364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical