Provider Demographics
NPI:1316055445
Name:SOUTHERN PIEDMONT SURGICAL SPECIALISTS, PLLC
Entity type:Organization
Organization Name:SOUTHERN PIEDMONT SURGICAL SPECIALISTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:LININGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD,FACS
Authorized Official - Phone:336-629-1000
Mailing Address - Street 1:149 MACARTHUR ST
Mailing Address - Street 2:
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27203-5410
Mailing Address - Country:US
Mailing Address - Phone:336-629-1000
Mailing Address - Fax:336-629-1300
Practice Address - Street 1:149 MACARTHUR ST
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-5410
Practice Address - Country:US
Practice Address - Phone:336-629-1000
Practice Address - Fax:336-629-1300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC015M8OtherBCBSNC GROUP ID NUMBER
NCDA8665OtherRAILROAD MEDICARE ID #
NC04377586OtherUNITED HEALTHCARE ID #
NC89015M8Medicaid
NC5274394OtherAETNA ID #
NC89015M8Medicaid
NC5274394OtherAETNA ID #
NC=========OtherMEDCOST ID #
NC=========OtherHEALTHCARE SAVINGS ID#
NC2335636Medicare ID - Type UnspecifiedMEDICARE GROUP ID NUMBER
NC89015M8Medicaid