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General NPI Number Information
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NPI Number | 1760773949
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Entity Type | Organization
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Legal Business Name | PIEDMONT OUTPATIENT SURGERY CENTER, LLC
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Dates
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Enumeration Date | 04/22/2011
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Last Update Date | 03/14/2012
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Provider Practice Location Address
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Address Line | 2465 HANESTOWN LANE
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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 | 336-201-0003
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Fax | 336-464-0736
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Provider Business Mailing Address
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Address Line | 2465 HANESTOWN LANE
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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 | 336-201-0003
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Fax | 336-464-0736
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. RONALD B. SHEALY
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Credential | M.D.
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Telephone | 336-768-3361
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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 |
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License Number State |
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