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Organization
IREDELL HEAD, NECK AND EAR AMBULATORY SURGERY CENTER, INC.
Active
Organization
IREDELL HEAD, NECK AND EAR AMBULATORY SURGERY CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK L. PRENDERGAST M.D. (PHYSICIAN DIRECTOR)
(704) 873-5224
Entity
Organization
Contact information
Practice address
707 BRYANT ST, LOWER LEVEL, STATESVILLE, NC 28677-4142
(704) 873-5224
(704) 924-8378
Mailing address
707 BRYANT ST, LOWER LEVEL, STATESVILLE, NC 28677-4142
(704) 873-5224
(704) 924-8378
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
AS0042
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3409865
—
NC
Enumeration date
03/15/2006
Last updated
02/18/2010
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