LAKE NORMAN SURGICAL ASSISTING; NPI #1093005878

Contact Information

LAKE NORMAN SURGICAL ASSISTING

1130 GRACE MEADOW DR
MOORESVILLE, NC 28115-2789

Phone: 704-663-4989
Fax:
Website:

	Specialty	Taxonomy Code	Specialty Code	Provider Type
	Surgical	363AS0400X	97	Physician Assistant

Indicates primary specialty

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NPI Profile & details for LAKE NORMAN SURGICAL ASSISTING

NPI # 1093005878

LBN Legal business name LAKE NORMAN SURGICAL ASSISTING

Authorized official CHARLES TUDOR - (MANAGING PARTNER)

Entity Organization

Organization subpart ¹ No

Enumeration date 04/13/2011

Last updated 04/01/2014 - About 12 years ago

Identifiers

NC	License #	101593
	Other	2348238	MEDICARE GROUP PTAN

¹ Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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LAKE NORMAN SURGICAL ASSISTING

Contact Information

Specialty

Surgical

NPI Profile & details for LAKE NORMAN SURGICAL ASSISTING

Reviews for LAKE NORMAN SURGICAL ASSISTING