# IREDELL PHYSICIAN NETWORK LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** IREDELL PHYSICIAN NETWORK LLC
- **Other names:** Iredell Ambulatory Surgery Center
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1578073631
- **Legal business name:** IREDELL PHYSICIAN NETWORK LLC
- **Authorized official:** JOANIE M COCHRAN (CREDENTIALING COORDINATOR)
- **Authorized official phone:** (336) 306-9755

## Contact information

- **Practice address:** 701 BRYANT ST, STATESVILLE, NC 28677-4142
- **Practice address phone:** (704) 380-2711
- **Practice address fax:** (704) 380-2747
- **Mailing address:** PO BOX 896199, CHARLOTTE, NC 28289-4107
- **Mailing address phone:** (446) 520-6118

## Taxonomy

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

## Other

- **Enumeration date:** 10/03/2017
- **Last updated:** 05/01/2024