Provider Demographics
NPI:1063538742
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 1:221 N GRAHAM HOPEDALE RD
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27217-2971
Mailing Address - Country:US
Mailing Address - Phone:336-532-0414
Mailing Address - Fax:336-570-3752
Practice Address - Street 1:221 N GRAHAM HOPEDALE RD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27217-2971
Practice Address - Country:US
Practice Address - Phone:336-532-0414
Practice Address - Fax:336-570-3752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15707183500000X
NC060273336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC34-4515BMedicaid
NC06027OtherNC BOP PERMIT #
NC3432060OtherNABP #
NCNC AC 0000 1130OtherNC CONTROLLED SUBSTANCE #
NCNC AC 0000 1130OtherNC CONTROLLED SUBSTANCE #
NCNC AC 0000 1130OtherNC CONTROLLED SUBSTANCE #