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LAKE NORMAN SURGICAL ASSISTING
NPI 1093005878
Physician Assistant - Surgical in Mooresville, NC

Active since April 13, 2011
1130 GRACE MEADOW DR, MOORESVILLE, NC 28115(704) 663-4989 Get Directions Write a Review

NPPES record last updated: April 1, 2014. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Lake Norman Surgical Assisting NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

LAKE NORMAN SURGICAL ASSISTING (NPI 1093005878) is a healthcare organization registered as a surgical in Mooresville, North Carolina and active in the NPI registry since April 2011. The organization lists Charles Anthony Tudor, Managing Partner, as its authorized official.

NPPES Registry Identity

NPI1093005878
Entity TypeOrganization
Primary Taxonomy363AS0400X
Legal Business NameLAKE NORMAN SURGICAL ASSISTING
Location Address1130 GRACE MEADOW DRMooresville, NC 28115-2789
Mailing Address1130 Grace Meadow DrMooresville, NC 28115-2789 · (704) 663-4989
Phone(704) 663-4989
Organization SubpartNo
Authorized OfficialCharles Anthony TudorManaging Partner · (704) 663-4989
Enumeration DateApril 13, 2011
Last NPPES UpdateApril 1, 2014
✔ NPI 1093005878 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician Assistant · SurgicalPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363AS0400X
License✔ Licensed in NC · 101593
1130 GRACE MEADOW DR, Mooresville, NC 28115
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Other Identifiers 1

Other2348238Medicare Group Ptan

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Lake Norman Surgical Assisting's NPI number?

The NPI number for Lake Norman Surgical Assisting is 1093005878. It was assigned to this organization in the NPPES registry on April 13, 2011.

Where is Lake Norman Surgical Assisting located?

Lake Norman Surgical Assisting is located at 1130 Grace Meadow Dr, Mooresville, NC 28115. The listed phone number is (704) 663-4989.

What is Lake Norman Surgical Assisting's specialty?

The primary specialty registered for this NPI is Physician Assistant, specializing in Surgical, with taxonomy code 363AS0400X.

When was this NPI record last updated?

The NPPES record for Lake Norman Surgical Assisting was last updated on April 1, 2014. NPI Profile syncs with the weekly NPPES data releases published by CMS.