Basic Information
| Provider Information | |||||||||
| NPI: | 1245210707 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PIEDMONT HEMATOLOGY-ONCOLOGY ASSOCIATES, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1010 BETHESDA CT | ||||||||
| Address2: | |||||||||
| City: | WINSTON SALEM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 271033019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3362778800 | ||||||||
| FaxNumber: | 3362778850 | ||||||||
| Practice Location | |||||||||
| Address1: | 1010 BETHESDA CT | ||||||||
| Address2: | |||||||||
| City: | WINSTON SALEM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 271033019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3362778800 | ||||||||
| FaxNumber: | 3362778850 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/20/2006 | ||||||||
| LastUpdateDate: | 03/02/2010 | ||||||||
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| AuthorizedOfficialLastName: | SHOEMAKER | ||||||||
| AuthorizedOfficialFirstName: | EMILY | ||||||||
| AuthorizedOfficialMiddleName: | GROCE | ||||||||
| AuthorizedOfficialTitleorPosition: | CREDENTIALING COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 3362778874 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology | 207RX0202X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology | 207VX0201X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecologic Oncology | 363AM0700X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 363L00000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LA2100X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care | 363LW0102X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health | 207RH0003X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 7538106 | 01 | NC | AETNA PPO GROUP NUMBER | OTHER | 3088997 | 01 | NC | AETNA HMO GROUP NUMBER | OTHER | 01226 | 01 | NC | BCBS PRACTICE GROUP NUMBE | OTHER | 89014M3 | 05 | NC | MEDICAID |