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General NPI Number Information
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NPI Number | 1689761546
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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 | 10/10/2006
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Last Update Date | 06/09/2015
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Provider Practice Location Address
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Address Line | 1025 NORTHEAST GATEWAY COURT, NE
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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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Provider Business Mailing Address
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Address Line | 1025 NORTHEAST GATEWAY COURT, NE
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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 | ADMINISTRATOR
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Name | ROBERT BASHORE
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Credential |
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Telephone | 704-920-7027
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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 | 060202
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | AS0070
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License Number State | NC
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