Healthcare Provider Details

I. General information

NPI: 1073497871
Provider Name (Legal Business Name): VALLEYGATE SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2025
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 TIMBER DRIVE
GARNER NC
27529
US

IV. Provider business mailing address

305 TIMBER DRIVE
GARNER NC
27529
US

V. Phone/Fax

Practice location:
  • Phone: 919-276-0900
  • Fax:
Mailing address:
  • Phone: 919-276-0900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: ERICA KENNERSON
Title or Position: DIRECTOR OF STRATEGIC DEVELOPMENT
Credential:
Phone: 337-356-7044