Organization
UPSTATE SURGERY CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEVIN LARSEN (CEO)
(631) 445-0593
Entity
Organization
Contact information
Practice address
10 ENTERPRISE BLVD STE 109, GREENVILLE, SC 29615-3534
(864) 813-7226
(864) 556-7552
Mailing address
9709 LAKESIDE BLVD STE 350, SPRING, TX 77381-1216
(713) 489-2198
(713) 489-2978
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
ASF-050
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ASC028
—
SC
Enumeration date
07/23/2006
Last updated
03/06/2026
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