Healthcare Provider Details

I. General information

NPI: 1093634891
Provider Name (Legal Business Name): VALLEYGATE SURGERY CENTER-MIDLAND LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3225 SUNSET BLVD
WEST COLUMBIA SC
29169-3453
US

IV. Provider business mailing address

PO BOX 87701
FAYETTEVILLE NC
28304-7701
US

V. Phone/Fax

Practice location:
  • Phone: 910-406-9455
  • Fax: 910-759-7441
Mailing address:
  • Phone: 910-406-9455
  • Fax: 910-759-7441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: VIRGINIA JONES
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 910-406-9455