Ambulatory Surgery Center of Spartanburg, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

ASF-064 Issued in SC

Legal business name

AMBULATORY SURGERY CENTER OF SPARTANBURG, LLC

Practice address

720 N Pine St
Spartanburg, SC 29303-3127

Phone

(864) 560-5800

Fax

(864) 560-5899

NPI assigned

Jun 16, 2005

Last updated

Dec 19, 2007By 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

Mr. Mike Pankey, R.N.

Title

Administrator

Phone

(864) 560-5821

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in SC

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1619972791. Details of each certification follow.

• CCN 420115 Hospital · Terminated · Name & address match · Details

Hospital certification: CCN 420115

Legal name

AMBULATORY SURGERY CENTER OF SPARTANBURG, LLC

Certification status

Terminated Voluntary: merger or closure, May 11, 2023

Provider type (POS)

Hospital – Short-term

Participating since

Apr 27, 2021

Last certification

Apr 27, 2021

Beds

2

Ownership / control type

Private (for profit)

Facility address

720 N Pine St
Spartanburg, SC 29303

Listed as

Ambulatory Surgery Center of SpartanburgCCN 42C0001041

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

• Anesthesia Services of the Upstate

  • Anesthesiology Physician
  • Spartanburg, SC
  • NPI 1083589923

  Member Of

  NPD member

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Mary Joan Black, MD

  • Orthopaedic Surgery Physician
  • Spartanburg, SC
  • NPI 1386655983
  NPD (past)

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

{
    "created_epoch": "1118880000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1198022400000",
    "number": "1619972791",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13740 CYPRESS TERRACE CIR",
            "address_2": "STE 501-503",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339078827",
            "telephone_number": "239-274-1000",
            "fax_number": "239-274-1001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "720 N PINE ST",
            "city": "SPARTANBURG",
            "state": "SC",
            "postal_code": "293033127",
            "telephone_number": "864-560-5800",
            "fax_number": "864-560-5899"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMBULATORY SURGERY CENTER OF SPARTANBURG, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-16",
        "last_updated": "2007-12-19",
        "status": "A",
        "authorized_official_last_name": "PANKEY",
        "authorized_official_first_name": "MIKE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "864-560-5821",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "R.N."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "SC",
            "license": "ASF-064",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Octavia Amaechi, MD
• Prince Keside Amaechi, M.D.
• Amb Healthtips & House Calls Inc
• Ambu-Sure (Ambu-Sure, LLC)
• Ambulatory Anesthesia, LLC
• Amendments Group, LLC
• Karina America
• American Health Imaging of South Carolina LLC (American Health Imaging of Spartanburg)
• Juliana Elisabeth Ames, MD
• Satya Kumar Amirichetty, M.D.

• Ambulatory Surgical Clinic/Center in Spartanburg, SC
• Providers in Spartanburg, SC by specialty
• Ambulatory Surgical Clinic/Center in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.