Healthcare Provider Details

I. General information

NPI: 1770743817
Provider Name (Legal Business Name): CARDIOVASCULAR AND THORACIC SURGEONS OF GREENSBORO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2008
Last Update Date: 06/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2704 HENRY ST
GREENSBORO NC
27405-3633
US

IV. Provider business mailing address

PO BOX 13605
GREENSBORO NC
27415-3605
US

V. Phone/Fax

Practice location:
  • Phone: 336-621-3777
  • Fax: 336-621-8374
Mailing address:
  • Phone: 336-547-1877
  • Fax: 336-547-1881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. ELIZABETH S WARD
Title or Position: CFO
Credential:
Phone: 336-832-8005