Healthcare Provider Details

I. General information

NPI: 1467329532
Provider Name (Legal Business Name): NORTH ELAM AMBULATORY SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2025
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 N ELAM AVE
GREENSBORO NC
27403-1129
US

IV. Provider business mailing address

509 N ELAM AVE
GREENSBORO NC
27403-1129
US

V. Phone/Fax

Practice location:
  • Phone: 336-240-3524
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: BRANDI CUNNINGHAM
Title or Position: VICE PRESIDENT OF OPERATIONS
Credential:
Phone: 336-240-3524