Provider Demographics
NPI:1952977563
Name:ATRIUM HEALTH HUNTERSVILLE ASC, LLC
Entity Type:Organization
Organization Name:ATRIUM HEALTH HUNTERSVILLE ASC, LLC
Other - Org Name:HUNTERSVILLE SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:WILDASIN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:704-801-1701
Mailing Address - Street 1:16455 STATESVILLE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-7137
Mailing Address - Country:US
Mailing Address - Phone:704-801-1701
Mailing Address - Fax:704-987-8403
Practice Address - Street 1:16455 STATESVILLE RD STE 100
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-7137
Practice Address - Country:US
Practice Address - Phone:704-801-1701
Practice Address - Fax:704-987-8403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-03
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
999999999999999999Other9999999999999999