Organization
KEYSTONE WSNC LLC
Active
Other names
Old Vineyard Physician Group
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STEVE FILTON (VICE PRESIDENT)
(610) 768-3300
Entity
Organization
Contact information
Practice address
3637 OLD VINEYARD RD, WINSTON SALEM, NC 27104
(336) 794-3550
(336) 794-4339
Mailing address
3637 OLD VINEYARD RD, WINSTON SALEM, NC 27104-4842
(336) 794-3550
(336) 794-4339
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
MHH0188
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5912567
—
NC
Enumeration date
08/28/2009
Last updated
09/04/2018
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