1235677634 NPI number — PIEDMONT ACCESS TO HEALTH SERVICES, INC

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 1235677634 NPI number — PIEDMONT ACCESS TO HEALTH SERVICES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PIEDMONT ACCESS TO HEALTH SERVICES, INC
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:
HEALTH CENTERS OF THE PIEDMONT SOUTH BOSTON
Provider Other Organization Name Type Code:
3
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:
1235677634
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/05/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
705 MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DANVILLE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24541-1803
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
434-791-4122
Provider Business Mailing Address Fax Number:
434-791-4088

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2524 HOUGHTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH BOSTON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24592
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-575-1336
Provider Business Practice Location Address Fax Number:
434-575-1349
Provider Enumeration Date:
02/06/2017

Additional Information

Authorized Official

Authorized Official Last Name:
MENDENHALL
Authorized Official First Name:
MARSHA
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
434-791-3630

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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