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General NPI Number Information
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NPI Number | 1619972791
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Entity Type | Organization
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Legal Business Name | AMBULATORY SURGERY CENTER OF SPARTANBURG, LLC
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Dates
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Enumeration Date | 06/16/2005
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Last Update Date | 12/19/2007
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Provider Practice Location Address
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Address Line | 720 N PINE ST
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City | SPARTANBURG
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State | SC
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Zip | 29303-3127
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Country | US
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Telephone | 864-560-5800
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Fax | 864-560-5899
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Provider Business Mailing Address
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Address Line | 13740 CYPRESS TERRACE CIR STE 501-503
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City | FORT MYERS
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State | FL
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Zip | 33907-8827
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Country | US
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Telephone | 239-274-1000
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Fax | 239-274-1001
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. MIKE PANKEY
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Credential | R.N.
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Telephone | 864-560-5821
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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 | ASF-064
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License Number State | SC
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