Provider Demographics
NPI:1457377954
Name:STONE INSTITUTE OF THE CAROLINAS LLC
Entity Type:Organization
Organization Name:STONE INSTITUTE OF THE CAROLINAS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:M
Authorized Official - Last Name:SURRATT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-822-5525
Mailing Address - Street 1:PO BOX 4509
Mailing Address - Street 2:
Mailing Address - City:DAVIDSON
Mailing Address - State:NC
Mailing Address - Zip Code:28036-4509
Mailing Address - Country:US
Mailing Address - Phone:800-822-5525
Mailing Address - Fax:704-892-8790
Practice Address - Street 1:215 SOUTH MAIN STREET
Practice Address - Street 2:SU 201
Practice Address - City:DAVIDSON
Practice Address - State:NC
Practice Address - Zip Code:28036-9307
Practice Address - Country:US
Practice Address - Phone:800-822-5525
Practice Address - Fax:704-892-8790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
208800000X
NCNOT REQUIRED IN NC261QL0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
No261QL0400XAmbulatory Health Care FacilitiesClinic/CenterLithotripsyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7902505Medicaid
NC2309606Medicare PIN