Provider Demographics
NPI:1023136132
Name:PIEDMONT HEALTH SERVICES, INC
Entity type:Organization
Organization Name:PIEDMONT HEALTH SERVICES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:LYDIA
Authorized Official - Middle Name:F
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-933-8494
Mailing Address - Street 1:7228 PITTSBORO MONCURE ROAD
Mailing Address - Street 2:
Mailing Address - City:MONCURE
Mailing Address - State:NC
Mailing Address - Zip Code:27559
Mailing Address - Country:US
Mailing Address - Phone:919-542-4991
Mailing Address - Fax:919-542-9957
Practice Address - Street 1:7228 PITTSBORO MONCURE ROAD
Practice Address - Street 2:
Practice Address - City:MONCURE
Practice Address - State:NC
Practice Address - Zip Code:27559
Practice Address - Country:US
Practice Address - Phone:919-542-4991
Practice Address - Fax:919-542-9957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC029963336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC344513BMedicaid
NC3408881OtherNABP
NC344513BMedicaid