1114943164 NPI number — PIEDMONT PODIATRY ASSOCIATES P A

Table of content: (NPI 1114943164)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114943164 NPI number — PIEDMONT PODIATRY ASSOCIATES P A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PIEDMONT PODIATRY ASSOCIATES P A
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114943164
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/27/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11 MILLS AVE
Provider Second Line Business Mailing Address:
C/O SUBODH CHOUDHARY
Provider Business Mailing Address City Name:
GREENVILLE
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29605-4015
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-232-3668
Provider Business Mailing Address Fax Number:
864-271-0526

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11 MILLS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENVILLE
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29605-4015
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-232-3668
Provider Business Practice Location Address Fax Number:
864-271-0526
Provider Enumeration Date:
07/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CHOUDHARY
Authorized Official First Name:
SUDOBH
Authorized Official Middle Name:
KUMAR
Authorized Official Title or Position:
OWNER PRESIDENT
Authorized Official Telephone Number:
864-232-3668

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: GP9955 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: AA32286626 . This is a "MEDICARE PTAN" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".




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