Healthcare Provider Details

I. General information

NPI: 1841135076
Provider Name (Legal Business Name): PATRIOTMED OF NORTH CAROLINA, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4410 PROVIDENCE LN STE G
WINSTON SALEM NC
27106-3242
US

IV. Provider business mailing address

4410 PROVIDENCE LN STE G
WINSTON SALEM NC
27106-3242
US

V. Phone/Fax

Practice location:
  • Phone: 336-602-2793
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ROBERT SCOTT THORNOCK
Title or Position: CHIEF STRATEGY OFFICER
Credential:
Phone: 480-369-1270