Provider Demographics
NPI:1528817590
Name:PIEDMONT HEALTH SERVICES, INC.
Entity type:Organization
Organization Name:PIEDMONT HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:LYDIA
Authorized Official - Middle Name:FUSE
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-933-8494
Mailing Address - Street 1:PO BOX 17179
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27516-7179
Mailing Address - Country:US
Mailing Address - Phone:919-933-8494
Mailing Address - Fax:919-933-9201
Practice Address - Street 1:4401 FULLER RD
Practice Address - Street 2:
Practice Address - City:EFLAND
Practice Address - State:NC
Practice Address - Zip Code:27243-9735
Practice Address - Country:US
Practice Address - Phone:919-563-5112
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PIEDMONT HEALTH SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-05-14
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)