Ambulatory Surgery Center of Spartanburg, LLC

Key facts

NPI: 1619972791
Entity type: Organization (NPI type 2)
Primary specialty: Ambulatory Surgical Clinic/Center 261QA1903X
License: ASF-064 (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
Organization subpart: No

Authorized official

Name: Mr. Mike Pankey, R.N.
Title: Administrator
Phone: (864) 560-5821

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

NPD member Member Of

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Mary Joan Black, MD Orthopaedic Surgery Physician · Spartanburg, SC · NPI 1386655983

NPD (past)

Medicare Care Compare: Ambulatory surgical center

Listed as: Ambulatory Surgery Center of Spartanburg CCN 42C0001041
Medicare certification status: Active (Provider of Services file)

Source: Medicare Care Compare.

Laboratory certificates & supplier records

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

CLIA laboratory certificates

CLIA number	Laboratory	Certificate	Expires
42D0996263	Ambulatory Surgery Ctr Spartanburg LLC 720 North Pine Street, Spartanburg, SC 29303	Certificate of waiver	Feb 12, 2028

Medicare participation

Medicare fee-for-service enrollment: Enrolled in SC

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
O20040805000592	SC	Part B Supplier - Ambulatory Surgical Center	9739150384	Practice locations: Spartanburg, SC

National Provider Directory

Locations

13740 Cypress Terrace Cir
Ste 501503
Fort Myers, FL 33907

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Ambulatory Surgical Clinic/Center	261QA1903X	ASF-064	SC	Yes

Addresses

Primary practice location

720 N Pine St
Spartanburg, SC 29303-3127

Mailing address

13740 Cypress Terrace Cir
Ste 501-503
Fort Myers, FL 33907-8827
Phone (239) 274-1000

Other identifiers

Identifier	Type	State	Issuer
ASC-037	Medicaid	SC
31910	Other		PARTNERS NATL HEALTH

Other providers in Spartanburg, SC

All providers in Spartanburg, SC · Ambulatory Surgical Clinic/Center in South Carolina

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 19, 2007. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
Medicare Care Compare provider data (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.