Organization Active NPI

Piedmont Gastroenterology Specialists, PA

  • Gastroenterology Physician
  • Winston Salem, NC
National Provider Identifier
1083715023
Registry record updated Oct 12, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
Legal business name
PIEDMONT GASTROENTEROLOGY SPECIALISTS, PA
Practice address
1901 S Hawthorne Rd
Suite 310
Winston Salem, NC 27103-3921
Phone
(336) 760-4340
Fax
(336) 765-2869
NPI assigned
Sep 25, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 12, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Michelle L Wallace, CMPE
Title
Practice Administrator
Phone
(336) 714-3544

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RG0100X Primary

Addresses

Primary practice location

1901 S Hawthorne Rd
Suite 310
Winston Salem, NC 27103-3921

Mailing address

1901 S Hawthorne Rd
Suite 310
Winston Salem, NC 27103-3921
Phone (336) 760-4340

Other identifiers 1

IdentifierTypeStateIssuer
8901548MedicaidNC

National Provider Directory

National Provider Directory

Locations

1901 S Hawthorne Rd
Ste 310
Winston Salem, NC 27103
Phone (336) 448-2427

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159142400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1350000000000",
    "number": "1083715023",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1901 S HAWTHORNE RD",
            "address_2": "SUITE 310",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271033921",
            "telephone_number": "336-760-4340",
            "fax_number": "336-765-2869"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1901 S HAWTHORNE RD",
            "address_2": "SUITE 310",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271033921",
            "telephone_number": "336-760-4340",
            "fax_number": "336-765-2869"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PIEDMONT GASTROENTEROLOGY SPECIALISTS, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-25",
        "last_updated": "2012-10-12",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "336-714-3544",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "CMPE"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8901548",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Winston Salem, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.