Lake Norman Surgical Assisting

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

101593 Issued in NC

Legal business name

LAKE NORMAN SURGICAL ASSISTING

Practice address

1130 Grace Meadow Dr
Mooresville, NC 28115-2789

Phone

(704) 663-4989

NPI assigned

Apr 13, 2011

Last updated

Apr 1, 2014By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Charles Anthony Tudor, PA-C

Title

Managing Partner

Phone

(704) 663-4989

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1302652800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1396310400000",
    "number": "1093005878",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1130 GRACE MEADOW DR",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281152789",
            "telephone_number": "704-663-4989"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1130 GRACE MEADOW DR",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281152789",
            "telephone_number": "704-663-4989"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE NORMAN SURGICAL ASSISTING",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-13",
        "last_updated": "2014-04-01",
        "status": "A",
        "authorized_official_last_name": "TUDOR",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "ANTHONY",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "704-663-4989",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant, Surgical",
            "state": "NC",
            "license": "101593",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP PTAN",
            "identifier": "2348238",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lake Norman Plastic Surgery
• Lake Norman Psychiatry & Counseling, PLLC
• Lake Norman Pulmonary & Sleep, PA
• Lake Norman Regional Medical Center-Home Health (Lake Norman Home Health)
• Lake Norman Sleep Center, PA
• Lake Norman Surgical Associates
• Lake Norman Urology PLLC
• Lakeshore Speech and Language Therapy, PLLC
• Lakeshore Women's Specialist, PC
• Lakeshore Women's Specialist, PC

• Surgical Physician Assistant in Mooresville, NC
• Providers in Mooresville, NC by specialty
• Surgical Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.