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General NPI Number Information
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NPI Number | 1003858721
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Entity Type | Organization
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Legal Business Name | PIEDMONT ENDOSCOPY CENTER, INC.
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Dates
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Enumeration Date | 06/10/2006
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Last Update Date | 10/12/2012
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Provider Practice Location Address
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Address Line | 1901 S HAWTHORNE RD SUITE 308
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City | WINSTON-SALEM
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State | NC
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Zip | 27103-3921
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Country | US
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Telephone | 336-760-4340
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Fax | 336-765-2869
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Provider Business Mailing Address
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Address Line | 1901 S HAWTHORNE RD SUITE 308
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City | WINSTON-SALEM
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State | NC
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Zip | 27103-3921
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Country | US
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Telephone | 336-760-4340
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Fax | 336-765-2869
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Authorized Official
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Title or Position | ASSITANT ADMINISTRATOR
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Name | MS. MICHELLE L WALLACE
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Credential | CMPE
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Telephone | 336-714-3544
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | AS0044
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License Number State | NC
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