Active NPI
Iredell Head, Neck and Ear Ambulatory Surgery Center, Inc.
- Ambulatory Surgical Clinic/Center
- Statesville, NC
National Provider Identifier
1710956529
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ambulatory Surgical Clinic/Center
- License
- AS0042
- Legal business name
- IREDELL HEAD, NECK AND EAR AMBULATORY SURGERY CENTER, INC.
- Practice address
- 707 Bryant St
Lower Level
Statesville, NC 28677-4142 - Phone
- (704) 873-5224
- Fax
- (704) 924-8378
- NPI assigned
- Mar 15, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Mark L. Prendergast, M.D.
- Title
- Physician Director
- Phone
- (704) 873-5224
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ambulatory Surgical Clinic/Center | 261QA1903X | AS0042 | NC | Primary |
Addresses
Primary practice location
707 Bryant St
Lower Level
Statesville, NC 28677-4142
Mailing address
707 Bryant St
Lower Level
Statesville, NC 28677-4142
Phone (704) 873-5224
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3409865 | Medicaid | NC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
Ambulatory surgical center certification: CCN 34C0001030
Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.
- Legal name
- IREDELL HEAD NECK & EAR SURGERY CENTER
- Certification status
- Active
- Provider type (POS)
- Ambulatory surgical center
- Participating since
- Feb 4, 1991
- Last certification
- Jul 18, 2017
- Ownership / control type
- Proprietary
- Facility address
- 707 Bryant St
Statesville, NC 28677
National Provider Directory
National Provider DirectoryLocations
707 Bryant St
Lowr
Statesville, NC 28677
Phone (704) 873-5224
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1142380800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1266451200000",
"number": "1710956529",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "707 BRYANT ST",
"address_2": "LOWER LEVEL",
"city": "STATESVILLE",
"state": "NC",
"postal_code": "286774142",
"telephone_number": "704-873-5224",
"fax_number": "704-924-8378"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "707 BRYANT ST",
"address_2": "LOWER LEVEL",
"city": "STATESVILLE",
"state": "NC",
"postal_code": "286774142",
"telephone_number": "704-873-5224",
"fax_number": "704-924-8378"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "IREDELL HEAD, NECK AND EAR AMBULATORY SURGERY CENTER, INC.",
"organizational_subpart": "NO",
"enumeration_date": "2006-03-15",
"last_updated": "2010-02-18",
"status": "A",
"authorized_official_last_name": "PRENDERGAST",
"authorized_official_first_name": "MARK",
"authorized_official_middle_name": "L.",
"authorized_official_title_or_position": "PHYSICIAN DIRECTOR",
"authorized_official_telephone_number": "704-873-5224",
"authorized_official_name_prefix": "Mr.",
"authorized_official_credential": "M.D."
},
"taxonomies": [
{
"code": "261QA1903X",
"taxonomy_group": "",
"desc": "Clinic/Center, Ambulatory Surgical",
"state": "NC",
"license": "AS0042",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3409865",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Statesville, NC
- Iredell County Group Services, PLLC
- Iredell County Health Department
- Iredell County Rescue Squad Inc
- Iredell Drug Care Inc.
- Iredell Drug Care, Inc
- Iredell Mem Hospital Cap Program
- Iredell Memorial Hosp SNF Icf
- Iredell Memorial Hospital Incorporated
- Iredell Memorial Hospital Incorporated
- Iredell Memorial Hospital Incorporated
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2010; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.