Healthcare Provider Details

I. General information

NPI: 1760773949
Provider Name (Legal Business Name): PIEDMONT OUTPATIENT SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2011
Last Update Date: 03/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2465 HANESTOWN LANE
WINSTON-SALEM NC
27103
US

IV. Provider business mailing address

2465 HANESTOWN LANE
WINSTON-SALEM NC
27103
US

V. Phone/Fax

Practice location:
  • Phone: 336-201-0003
  • Fax: 336-464-0736
Mailing address:
  • Phone: 336-201-0003
  • Fax: 336-464-0736

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: DR. RONALD B. SHEALY
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 336-768-3361