Healthcare Provider Details

I. General information

NPI: 1184801565
Provider Name (Legal Business Name): MEBANE ASC INVESTORS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2008
Last Update Date: 01/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3940 ARROWHEAD BLVD
MEBANE NC
27302
US

IV. Provider business mailing address

PO BOX 1010
MEBANE NC
27302-1010
US

V. Phone/Fax

Practice location:
  • Phone: 919-943-0120
  • Fax: 336-586-3592
Mailing address:
  • Phone: 919-943-0120
  • Fax: 336-586-3592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: VALERIE V BRICKEY
Title or Position: ADMINISTRATOR
Credential:
Phone: 919-943-0120