Organization
NORTHEAST SURGICAL SPECIALTIES, LLC
Active
Parent organization
NORTHEAST SURGICAL SPECIALTIES, LLC
Other names
Piedmont Orthopedic Specialists - Poplar Tent
Organization subpart
Yes
Provider details
NPI number
Legal business name
NORTHEAST SURGICAL SPECIALTIES, LLC
Authorized official
THOMAS F LAYMON (SR VP)
(704) 403-2276
Entity
Organization
Contact information
Practice address
5651 POPLAR TENT RD, SUITE 200, CONCORD, NC 28027-7530
(704) 403-7020
(704) 403-7039
Mailing address
5651 POPLAR TENT RD, SUITE 200, CONCORD, NC 28027-7530
(704) 403-7020
(704) 403-7039
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2342616
MEDICARE PTAN, GROUP
NC
05
—
5914068
—
NC
01
—
DO1210
RAILROAD MEDICARE PTAN
NC
Enumeration date
01/26/2010
Last updated
01/26/2016
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