1114360427 NPI number — PIEDMONT NEUROLOGY OF THE UPSTATE, PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114360427 NPI number — PIEDMONT NEUROLOGY OF THE UPSTATE, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PIEDMONT NEUROLOGY OF THE UPSTATE, PA
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:
1114360427
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/17/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 HEALTHY WAY
Provider Second Line Business Mailing Address:
SUITE 1240
Provider Business Mailing Address City Name:
ANDERSON
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29621-7915
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-964-9155
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 HEALTHY WAY
Provider Second Line Business Practice Location Address:
SUITE 1240
Provider Business Practice Location Address City Name:
ANDERSON
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29621-7915
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-964-9155
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/17/2013

Additional Information

Authorized Official

Authorized Official Last Name:
CARR
Authorized Official First Name:
WESLEY
Authorized Official Middle Name:
ALLEN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
864-964-9155

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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