Basic Information
| Provider Information | |||||||||
| NPI: | 1497058804 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PIEDMONT HEALTH SERVICES, INC | ||||||||
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| OtherOrganizationName: | BURLINGTON COMMUNITY HEALTH CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 299 LLOYD ST | ||||||||
| Address2: | |||||||||
| City: | CARRBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275101821 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199338494 | ||||||||
| FaxNumber: | 9199339201 | ||||||||
| Practice Location | |||||||||
| Address1: | 1214 VAUGHN RD | ||||||||
| Address2: | STE 101 | ||||||||
| City: | BURLINGTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 272172863 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3365320000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/08/2010 | ||||||||
| LastUpdateDate: | 05/05/2014 | ||||||||
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| AuthorizedOfficialLastName: | TOOMEY | ||||||||
| AuthorizedOfficialFirstName: | BRIAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 9199338494 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X | NC | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
No ID Information.