Healthcare Provider Details

I. General information

NPI: 1063416998
Provider Name (Legal Business Name): WILMINGTON SURGERY CENTER, LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 07/24/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 S 17TH ST
WILMINGTON NC
28401-6443
US

IV. Provider business mailing address

1801 S 17TH ST
WILMINGTON NC
28401-6443
US

V. Phone/Fax

Practice location:
  • Phone: 910-763-4555
  • Fax: 910-343-4922
Mailing address:
  • Phone: 910-763-4555
  • Fax: 910-343-4922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberAS0055
License Number StateNC

VIII. Authorized Official

Name: ANDREA SMITH-JONES
Title or Position: VP ASC OPERATIONS
Credential:
Phone: 704-907-3705