Healthcare Provider Details

I. General information

NPI: 1760492326
Provider Name (Legal Business Name): WINSTON NEUROLOGY, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 07/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1492 RYMCO DRIVE
WINSTON SALEM NC
27103
US

IV. Provider business mailing address

1492 RYMCO DRIVE
WINSTON-SALEM NC
27103
US

V. Phone/Fax

Practice location:
  • Phone: 336-765-5553
  • Fax: 336-765-5359
Mailing address:
  • Phone: 336-765-5553
  • Fax: 336-765-5359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MRS. LUCIE M. LOUVE
Title or Position: VICE PRESIDENT
Credential: MD
Phone: 336-765-5553