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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