# CHARLOTTE SURGERY CENTER, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Charlotte Surgery Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1891750998
- **Authorized official:** THOMAS LALLY (CHIEF ADMINISTRATIVE OFFICER)
- **Authorized official phone:** (704) 377-1647

## Contact information

- **Practice address:** 2825 RANDOLPH RD, CHARLOTTE, NC 28211-1075
- **Practice address phone:** (704) 377-1647
- **Mailing address:** 2825 RANDOLPH RD, CHARLOTTE, NC 28211-1018
- **Mailing address phone:** (704) 377-1674
- **Mailing address fax:** (704) 358-8267

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | AS0026 | NC | Yes |
| 261QA1903X | Ambulatory Surgical Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 04/20/2006
- **Last updated:** 10/15/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 3409842 | — | NC |