1760439483 NPI number — PIEDMONT INTERNAL MEDICINE, INC

Table of content: (NPI 1760439483)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760439483 NPI number — PIEDMONT INTERNAL MEDICINE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PIEDMONT INTERNAL MEDICINE, 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:
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:
1760439483
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/04/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
125 EXECUTIVE DR
Provider Second Line Business Mailing Address:
SUITE H
Provider Business Mailing Address City Name:
DANVILLE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24541-4155
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
434-791-1345
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
125 EXECUTIVE DR
Provider Second Line Business Practice Location Address:
SUITE H
Provider Business Practice Location Address City Name:
DANVILLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24541-4155
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-791-1345
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MOSS
Authorized Official First Name:
VICKIE
Authorized Official Middle Name:
E
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
434-791-1345

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: C10394 . This is a "MEDICARE GROUP" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 006237 . This is a "ANTHEM GROUP NUMBER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 8901421 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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