MEDICARE: PIEDMONT INFUSION SERVICES, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)	5734	VA

General Provider Information

NPI Number	:	1023253895
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PIEDMONT INFUSION SERVICES, INC

Provider Business Mailing Address
First Line	:	111 MALL DR
Second Line	:
City	:	DANVILLE
State	:	VA
Zip	:	24540-4069
Country	:	US
Telephone Number	:	434-792-6387
Fax Number	:	434-792-6389

Provider Business Practice Location Address
First Line	:	111 MALL DR
Second Line	:
City	:	DANVILLE
State	:	VA
Zip	:	24540-4069
Country	:	US
Telephone Number	:	434-792-6387
Fax Number	:	434-792-6389

Authorized Official
Title or Position	:	OWNER
Name	:	MR. JACOB BETHEL PATTERSON JR.
Credential	:	RPH
Telephone Number	:	434-792-6387

Provider Enumeration Date	:	12/09/2008
Last Update Date	:	10/12/2022

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