Provider Demographics
NPI:1760773949
Name:PIEDMONT OUTPATIENT SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:PIEDMONT OUTPATIENT SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:B
Authorized Official - Last Name:SHEALY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-768-3361
Mailing Address - Street 1:2465 HANESTOWN LANE
Mailing Address - Street 2:
Mailing Address - City:WINSTON-SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103
Mailing Address - Country:US
Mailing Address - Phone:336-201-0003
Mailing Address - Fax:336-464-0736
Practice Address - Street 1:2465 HANESTOWN LANE
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:336-201-0003
Practice Address - Fax:336-464-0736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-22
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical