# NOVANT HEALTH CLEMMONS OUTPATIENT SURGERY, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1528521887
- **Authorized official:** GERALD OSBORNE GREEN (ADMINISTRATOR ASC)
- **Authorized official phone:** (336) 277-1782

## Contact information

- **Practice address:** 7210 VILLAGE MEDICAL CIRCLE, SUITE \# 235, CLEMMONS, NC 27012
- **Practice address phone:** (336) 893-3100
- **Practice address fax:** (336) 893-3109
- **Mailing address:** 101 N CHERRY ST STE 600, WINSTON SALEM, NC 27101-4013
- **Mailing address phone:** (336) 277-1604
- **Mailing address fax:** (336) 277-9584

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 04/12/2019
- **Last updated:** 03/30/2021