Healthcare Provider Details

I. General information

NPI: 1396342481
Provider Name (Legal Business Name): PIEDMONT ASC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2020
Last Update Date: 09/17/2024
Certification Date: 09/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7819 NATIONAL SERVICE RD STE 404
GREENSBORO NC
27409-9401
US

IV. Provider business mailing address

14201 DALLAS PKWY
DALLAS TX
75254-2916
US

V. Phone/Fax

Practice location:
  • Phone: 336-664-0333
  • Fax: 336-664-0447
Mailing address:
  • Phone: 972-763-3859
  • Fax: 972-920-3445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KRISTEN OCONNOR
Title or Position: OFFICER/AUTHORIZED OFFICIAL
Credential:
Phone: 615-376-7315