Organization
PREMIER SURGERY CENTER OF THE CAROLINAS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. IVAN MAC MD (FOUNDING MEMBER)
(704) 254-9099
Entity
Organization
Contact information
Practice address
1170 EDGEWATER CORPORATE PKWY STE 106, INDIAN LAND, SC 29707-4607
(803) 239-4504
Mailing address
4101 CAMPUS RIDGE RD, MATTHEWS, NC 28105-5077
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
—
—
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Enumeration date
10/18/2024
Last updated
06/30/2025
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