Healthcare Provider Details

I. General information

NPI: 1427528595
Provider Name (Legal Business Name): TRIAD SEDATION ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2018
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 FRONTIS PLAZA BLVD STE 200
WINSTON SALEM NC
27103-5663
US

IV. Provider business mailing address

PO BOX 739580
DALLAS TX
75373-9580
US

V. Phone/Fax

Practice location:
  • Phone: 336-768-6211
  • Fax: 336-768-6869
Mailing address:
  • Phone: 888-717-5383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: JEFF PERRY
Title or Position: MANAGER
Credential:
Phone: 502-418-4700