Organization
PIEDMONT TRIAD ANESTHESIA, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS LUKISH III (PRACTICE ADMINISTRATOR)
(336) 768-3212
Entity
Organization
Contact information
Practice address
145 KIMEL PARK DR, SUITE 120, WINSTON-SALEM, NC 27103-6983
(336) 768-3212
(336) 768-9019
Mailing address
145 KIMEL PARK DR, SUITE 120, WINSTON SALEM, NC 27103-6983
(336) 768-3212
(336) 768-9019
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
367500000X
Certified Registered Nurse Anesthetist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
016HA
BCBS
NC
05
—
8000325
—
NC
05
—
89016HA
—
NC
01
—
DC6484
RR MEDICARE
NC
Enumeration date
06/18/2006
Last updated
02/08/2023
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