Provider Demographics
NPI:1679687586
Name:GASTROENTEROLOGY ASSOCIATES OF THE PIEDMONT, P.A.
Entity Type:Organization
Organization Name:GASTROENTEROLOGY ASSOCIATES OF THE PIEDMONT, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:C
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, FACMPE
Authorized Official - Phone:336-714-3533
Mailing Address - Street 1:1830 S HAWTHORNE RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-4047
Mailing Address - Country:US
Mailing Address - Phone:336-448-2427
Mailing Address - Fax:336-765-2869
Practice Address - Street 1:875 BETHESDA RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103
Practice Address - Country:US
Practice Address - Phone:336-448-2427
Practice Address - Fax:336-765-2869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207RG0100X
NC261QE0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopyGroup - Multi-Specialty
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
7282490OtherAETNA GROUP #
NC89-02591Medicaid
02591OtherBLUE CROSS BLUE SHIELD NC
02591OtherBLUE CROSS BLUE SHIELD NC