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Organization
PREMIER SURGERY CENTER OF THE CAROLINAS, LLC
Active
Organization
PREMIER SURGERY CENTER OF THE CAROLINAS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. IVAN MAC MD (FOUNDING MEMBER)
(704) 254-9099
Entity
Organization
Contact information
Practice address
1170 EDGEWATER CORPORATE PKWY STE 106, INDIAN LAND, SC 29707-4607
(803) 239-4504
Mailing address
4101 CAMPUS RIDGE RD, MATTHEWS, NC 28105-5077
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
—
NULL
207W00000X
Ophthalmology Physician
—
—
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
NULL
Other
Enumeration date
10/18/2024
Last updated
06/30/2025
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