Basic Information
| Provider Information | |||||||||
| NPI: | 1831662485 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PIEDMONT HEALTHCARE, PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1845 | ||||||||
| Address2: | |||||||||
| City: | STATESVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286871845 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7048734277 | ||||||||
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| Practice Location | |||||||||
| Address1: | 375 HOSPITAL ST | ||||||||
| Address2: | |||||||||
| City: | MOCKSVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 270282086 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3367512121 | ||||||||
| FaxNumber: | 3367512123 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/07/2019 | ||||||||
| LastUpdateDate: | 01/07/2019 | ||||||||
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| AuthorizedOfficialLastName: | GUIN | ||||||||
| AuthorizedOfficialFirstName: | GREG | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 7048734277 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.