Basic Information
Provider Information
NPI: 1396342481
EntityType: 2
ReplacementNPI:  
OrganizationName: PIEDMONT ASC LLC
LastName:  
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Mailing Information
Address1: 14201 DALLAS PKWY
Address2:  
City: DALLAS
State: TX
PostalCode: 752542916
CountryCode: US
TelephoneNumber: 9727633859
FaxNumber: 9729203445
Practice Location
Address1: 7819 NATIONAL SERVICE RD STE 404
Address2:  
City: GREENSBORO
State: NC
PostalCode: 274099401
CountryCode: US
TelephoneNumber: 3366640333
FaxNumber: 3366640447
Other Information
ProviderEnumerationDate: 10/02/2020
LastUpdateDate: 10/02/2020
NPIDeactivationReasonCode:  
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AuthorizedOfficialLastName: DANNA
AuthorizedOfficialFirstName: TERESA
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AuthorizedOfficialTitleorPosition: OFFICER/AUTHORIZED OFFICIAL
AuthorizedOfficialTelephone: 9727633890
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
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NPICertificationDate: 10/02/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
261QA1903X  Y Ambulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical

No ID Information.


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