Basic Information
| Provider Information | |||||||||
| NPI: | 1457099152 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LENOIR ASC LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5221 PARAMOUNT PKWY STE 440 | ||||||||
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| City: | MORRISVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275605491 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9849741183 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2602 N HERRITAGE ST | ||||||||
| Address2: | |||||||||
| City: | KINSTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 285011503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2525276565 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2022 | ||||||||
| LastUpdateDate: | 05/23/2022 | ||||||||
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| AuthorizedOfficialLastName: | WAKEFIELD | ||||||||
| AuthorizedOfficialFirstName: | JEFFREY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 2525227905 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 05/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.