Basic Information
Provider Information | |||||||||
NPI: | 1750390654 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | PIEDMONT HOME CARE | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | FAUQUIER HEALTH HOME MEDICAL STORE | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 1910 | ||||||||
Address2: |   | ||||||||
City: | WINCHESTER | ||||||||
State: | VA | ||||||||
PostalCode: | 226048060 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5405365229 | ||||||||
FaxNumber: | 5405362396 | ||||||||
Practice Location | |||||||||
Address1: | 129 WEST LEE HIGHWAY | ||||||||
Address2: |   | ||||||||
City: | WARRENTON | ||||||||
State: | VA | ||||||||
PostalCode: | 20186 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5403491279 | ||||||||
FaxNumber: | 5403491286 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/07/2006 | ||||||||
LastUpdateDate: | 07/29/2008 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | HEISEY | ||||||||
AuthorizedOfficialFirstName: | M | ||||||||
AuthorizedOfficialMiddleName: | FRANK | ||||||||
AuthorizedOfficialTitleorPosition: | TRESURER | ||||||||
AuthorizedOfficialTelephone: | 5405365260 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X |   |   | Y |   | Suppliers | Durable Medical Equipment & Medical Supplies |   |
ID Information
ID | Type | State | Issuer | Description | 01319498 | 05 | VA |   | MEDICAID |