Provider Demographics
NPI:1194788935
Name:PIEDMONT RADIOLOGICAL ASSOCIATES, P.A.
Entity type:Organization
Organization Name:PIEDMONT RADIOLOGICAL ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:HURLOCKER
Authorized Official - Last Name:EAGLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-633-1022
Mailing Address - Street 1:401 MOCKSVILLE AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-2735
Mailing Address - Country:US
Mailing Address - Phone:704-633-1022
Mailing Address - Fax:704-633-6711
Practice Address - Street 1:401 MOCKSVILLE AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-2735
Practice Address - Country:US
Practice Address - Phone:704-633-1022
Practice Address - Fax:704-633-6711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8902420Medicaid
NC149583OtherMAMMOGRAPHY CERTIFICATION
NC8902420Medicaid