1770743817 NPI number — CARDIOVASCULAR AND THORACIC SURGEONS OF GREENSBORO

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770743817 NPI number — CARDIOVASCULAR AND THORACIC SURGEONS OF GREENSBORO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARDIOVASCULAR AND THORACIC SURGEONS OF GREENSBORO
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
TRIAD CARDIAC AND THORACIC SURGERY / VASCULAR AND VEIN SPECIALISTS OF
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770743817
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/12/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 13605
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENSBORO
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27415-3605
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-547-1877
Provider Business Mailing Address Fax Number:
336-547-1881

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2704 HENRY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENSBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27405-3633
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-621-3777
Provider Business Practice Location Address Fax Number:
336-621-8374
Provider Enumeration Date:
06/12/2008

Additional Information

Authorized Official

Authorized Official Last Name:
WARD
Authorized Official First Name:
ELIZABETH
Authorized Official Middle Name:
S
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
336-832-8005

Provider Taxonomy Codes

  • Taxonomy code: 2086S0129X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208G00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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