MEDICARE: PRESBYTERIAN SAMEDAY SURGERY CENTER AT BALLANTYNE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1215061049
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRESBYTERIAN SAMEDAY SURGERY CENTER AT BALLANTYNE LLC

Provider Business Mailing Address
First Line	:	2085 FRONTIS PLAZA BLVD
Second Line	:
City	:	WINSTON-SALEM
State	:	NC
Zip	:	27103
Country	:	US
Telephone Number	:	336-277-1065
Fax Number	:	336-277-9274

Provider Business Practice Location Address
First Line	:	14215 BALLANTYNE CORPORATE PL STE 210
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28277-3873
Country	:	US
Telephone Number	:	704-316-2650
Fax Number	:	704-316-2653

Authorized Official
Title or Position	:	EVP CFO
Name	:	FRED M. HARGETT
Credential	:
Telephone Number	:	704-384-5184

Provider Enumeration Date	:	03/15/2007
Last Update Date	:	10/04/2018

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