Basic Information
| Provider Information | |||||||||
| NPI: | 1528521887 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NOVANT HEALTH CLEMMONS OUTPATIENT SURGERY, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101 N CHERRY ST STE 600 | ||||||||
| Address2: | |||||||||
| City: | WINSTON SALEM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 271014013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3362771604 | ||||||||
| FaxNumber: | 3362779584 | ||||||||
| Practice Location | |||||||||
| Address1: | 7210 VILLAGE MEDICAL CIRCLE | ||||||||
| Address2: | SUITE # 235 | ||||||||
| City: | CLEMMONS | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3368933100 | ||||||||
| FaxNumber: | 3368933109 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2019 | ||||||||
| LastUpdateDate: | 03/30/2021 | ||||||||
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| AuthorizedOfficialLastName: | GREEN | ||||||||
| AuthorizedOfficialFirstName: | GERALD | ||||||||
| AuthorizedOfficialMiddleName: | OSBORNE | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR ASC | ||||||||
| AuthorizedOfficialTelephone: | 3362771782 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 03/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.