Provider Demographics
NPI:1669477105
Name:TRIAD SURGICAL ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:TRIAD SURGICAL ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LUANN
Authorized Official - Middle Name:F
Authorized Official - Last Name:STEELE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-765-0155
Mailing Address - Street 1:2933 MAPLEWOOD AVE
Mailing Address - Street 2:STE 4
Mailing Address - City:WINSTON-SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-4001
Mailing Address - Country:US
Mailing Address - Phone:336-765-0155
Mailing Address - Fax:336-765-5494
Practice Address - Street 1:2933 MAPLEWOOD AVE
Practice Address - Street 2:STE 4
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-4001
Practice Address - Country:US
Practice Address - Phone:336-765-0155
Practice Address - Fax:336-765-5494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0283MMedicaid
NCE50728Medicare UPIN
NCD61152Medicare UPIN
NCC80429Medicare UPIN
2310312Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER
NCC78368Medicare UPIN