# IREDELL HEAD, NECK AND EAR AMBULATORY SURGERY CENTER, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1710956529
- **Authorized official:** MR. MARK L. PRENDERGAST M.D. (PHYSICIAN DIRECTOR)
- **Authorized official phone:** (704) 873-5224

## Contact information

- **Practice address:** 707 BRYANT ST, LOWER LEVEL, STATESVILLE, NC 28677-4142
- **Practice address phone:** (704) 873-5224
- **Practice address fax:** (704) 924-8378
- **Mailing address:** 707 BRYANT ST, LOWER LEVEL, STATESVILLE, NC 28677-4142
- **Mailing address phone:** (704) 873-5224
- **Mailing address fax:** (704) 924-8378

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | AS0042 | NC | Yes |

## Other

- **Enumeration date:** 03/15/2006
- **Last updated:** 02/18/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 3409865 | — | NC |