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General NPI Number Information
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NPI Number | 1336529197
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Entity Type | Organization
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Legal Business Name | TWINCITY MEDICAL MOBILE DIAGNOSTICS
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Dates
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Enumeration Date | 06/05/2015
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Last Update Date | 09/12/2018
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Provider Practice Location Address
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Address Line | 163 STRATFORD CT
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City | WINSTON SALEM
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State | NC
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Zip | 27103
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Country | US
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Telephone | 336-816-6800
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Fax | 888-507-6778
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Provider Business Mailing Address
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Address Line | 163 STRATFORD CT
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City | WINSTON SALEM
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State | NC
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Zip | 27103-1836
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Country | US
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Telephone | 336-816-6800
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Fax | 888-507-6778
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. RICHARD O. CORNWALL
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Credential | PA-C
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Telephone | 336-816-6800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0208X
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Taxonomy Name | Mobile Radiology Clinic/Center
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License Number | 21159
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 335V00000X
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Taxonomy Name | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
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License Number | 21159
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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