Healthcare Provider Details

I. General information

NPI: 1457377954
Provider Name (Legal Business Name): STONE INSTITUTE OF THE CAROLINAS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 01/04/2024
Certification Date: 01/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 SOUTH MAIN STREET SU 201
DAVIDSON NC
28036-9307
US

IV. Provider business mailing address

PO BOX 4509
DAVIDSON NC
28036-4509
US

V. Phone/Fax

Practice location:
  • Phone: 800-822-5525
  • Fax: 704-892-8790
Mailing address:
  • Phone: 800-822-5525
  • Fax: 704-892-8790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QL0400X
TaxonomyLithotripsy Clinic/Center
License NumberNOT REQUIRED IN NC
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier7902505
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer

VIII. Authorized Official

Name: DOUGLAS M SURRATT
Title or Position: COO
Credential:
Phone: 800-822-5525