# IREDELL PHYSICIAN NETWORK, LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** IREDELL PHYSICIAN NETWORK, LLC
- **Other names:** Iredell Surgery at Mooresville ASC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1518549393
- **Legal business name:** IREDELL PHYSICIAN NETWORK, LLC
- **Authorized official:** CARLA D JOHNSON (DIRECTOR OF OPERATIONS)
- **Authorized official phone:** (704) 873-5661

## Contact information

- **Practice address:** 653 BLUEFIELD ROAD, SUITE D, MOORESVILLE, NC 28117
- **Practice address phone:** (704) 883-3378
- **Practice address fax:** (704) 883-3228
- **Mailing address:** PO BOX 896199, CHARLOTTE, NC 28289-6199
- **Mailing address phone:** (833) 936-1364
- **Mailing address fax:** (605) 942-7505

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 04/22/2021
- **Last updated:** 05/25/2021