NPIMap

Organization Active NPI

Twincity Medical Mobile Diagnostics

  • Specialist
  • Winston Salem, NC
National Provider Identifier
1336529197
Registry record updated Sep 12, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
TWINCITY MEDICAL MOBILE DIAGNOSTICS
Practice address
163 Stratford CT
Winston Salem, NC 27103
Phone
(336) 816-6800
Fax
(888) 507-6778
NPI assigned
Jun 5, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 12, 2018

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

Authorized official

Name
Mr. Richard O. Cornwall, PA-CNPI 1780643197
Title
President
Phone
(336) 816-6800

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X Primary
Mobile Radiology Clinic/Center 261QR0208X 21159 NC
Portable X-ray and/or Other Portable Diagnostic Imaging Supplier 335V00000X 21159 NC

Addresses

Primary practice location

163 Stratford CT
Winston Salem, NC 27103

Mailing address

163 Stratford CT
Winston Salem, NC 27103-1836
Phone (336) 816-6800

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1336529197. Details of each certification follow.

Portable X-ray supplier certification: CCN 34X0009837

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
TWINCITY MEDICAL MOBILE DIAGNOSTICS
Certification status
Active
Provider type (POS)
Portable X-ray supplier
Participating since
Dec 27, 2017
Last certification
Nov 15, 2017
Ownership / control type
Corporation
Facility address
163 Stratford Court Suite 110
Winston Salem, NC 27103

National Provider Directory

National Provider Directory

Locations

163 Stratford Ct
Winston Salem, NC 27103
Phone (336) 448-4123

1001 S Marshall St
Ste 17
Winston Salem, NC 27101
Phone (336) 816-6800

163 Stratford Ct
Ste 110
Winston Salem, NC 27103
Phone (336) 816-6800

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1433462400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1536710400000",
    "number": "1336529197",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "163 STRATFORD CT",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271031836",
            "telephone_number": "336-816-6800",
            "fax_number": "888-507-6778"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "163 STRATFORD CT",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "27103",
            "telephone_number": "336-816-6800",
            "fax_number": "888-507-6778"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TWINCITY MEDICAL MOBILE DIAGNOSTICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-05",
        "last_updated": "2018-09-12",
        "status": "A",
        "authorized_official_last_name": "CORNWALL",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "O.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "336-816-6800",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QR0208X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology, Mobile",
            "state": "NC",
            "license": "21159",
            "primary": false
        },
        {
            "code": "335V00000X",
            "taxonomy_group": "",
            "desc": "Portable X-ray and/or Other Portable Diagnostic Imaging Supplier",
            "state": "NC",
            "license": "21159",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Winston Salem, NC

Sources for this page

Verify at the official NPI Registry.