Provider Demographics
NPI:1871559237
Name:PIEDMONT NEUROSURGERY & SPINE, PA
Entity type:Organization
Organization Name:PIEDMONT NEUROSURGERY & SPINE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:P
Authorized Official - Last Name:SYWENKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-645-0901
Mailing Address - Street 1:330 JAKE ALEXANDER BLVD W
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28147-1384
Mailing Address - Country:US
Mailing Address - Phone:704-645-0901
Mailing Address - Fax:704-645-0907
Practice Address - Street 1:330 JAKE ALEXANDER BLVD W
Practice Address - Street 2:SUITE 104
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28147-1384
Practice Address - Country:US
Practice Address - Phone:704-645-0901
Practice Address - Fax:704-645-0907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-25
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89012G2Medicaid
NC012G2OtherBCBS OF NC PROVIDER NUMBE
NCCH8673OtherRRMED/'RAILROAD MEDICARE
NCCH8673OtherRRMED/'RAILROAD MEDICARE
NC012G2OtherBCBS OF NC PROVIDER NUMBE