Basic Information
| Provider Information | |||||||||
| NPI: | 1942488903 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PIEDMONT PULMONOLOGY, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 S HERLONG AVE | ||||||||
| Address2: | SUITE E-1 | ||||||||
| City: | ROCK HILL | ||||||||
| State: | SC | ||||||||
| PostalCode: | 297323399 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8033241950 | ||||||||
| FaxNumber: | 8033241933 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 S HERLONG AVE | ||||||||
| Address2: | SUITE E-1 | ||||||||
| City: | ROCK HILL | ||||||||
| State: | SC | ||||||||
| PostalCode: | 297323399 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8033241950 | ||||||||
| FaxNumber: | 8033241933 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/01/2008 | ||||||||
| LastUpdateDate: | 06/23/2016 | ||||||||
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| AuthorizedOfficialLastName: | JAMES | ||||||||
| AuthorizedOfficialFirstName: | WESLEY | ||||||||
| AuthorizedOfficialMiddleName: | O. | ||||||||
| AuthorizedOfficialTitleorPosition: | REGIONAL CFO, TENET | ||||||||
| AuthorizedOfficialTelephone: | 4042655009 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0200X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207RP1001X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | 208000000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | 2080P0203X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Critical Care Medicine | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | GP4845 | 05 | SC | MEDICAID |