Organization
WAVECO LLC
Active
Other names
Carolina Center for Specialty Surgery
Organization subpart
No
Provider details
NPI number
Authorized official
TROY BOUZAKIS (CEO)
(704) 376-1605
Entity
Organization
Contact information
Practice address
1822 BRUNSWICK AVE, CHARLOTTE, NC 28207-1820
(704) 831-4400
(704) 831-4401
Mailing address
1822 BRUNSWICK AVE, CHARLOTTE, NC 28207-1820
(704) 831-4400
(704) 831-4401
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
AS0058
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1760418917
—
NC
Enumeration date
06/22/2006
Last updated
05/15/2026
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