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General NPI Number Information
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NPI Number | 1144312075
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Entity Type | Organization
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Legal Business Name | GATEWAY AMBULATORY SURGERY CENTER LLC
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Dates
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Enumeration Date | 09/28/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1025 NORTHEAST GATEWAY COURT
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City | CONCORD
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State | NC
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Zip | 28025-2440
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Country | US
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Telephone | 704-920-7020
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Fax | 704-920-7063
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Provider Business Mailing Address
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Address Line | 1025 NORTHEAST GATEWAY COURT
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City | CONCORD
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State | NC
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Zip | 28025
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Country | US
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Telephone | 704-920-7020
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Fax | 704-920-7063
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. MARK S NANTZ
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Credential |
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Telephone | 704-783-3000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | AS0070
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License Number State | NC
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