Healthcare Provider Details

I. General information

NPI: 1013555036
Provider Name (Legal Business Name): PIEDMONT HEALTH SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2019
Last Update Date: 12/20/2019
Certification Date: 12/20/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 LLOYD ST
CARRBORO NC
27510-1823
US

IV. Provider business mailing address

PO BOX 17179
CHAPEL HILL NC
27516-7179
US

V. Phone/Fax

Practice location:
  • Phone: 919-942-8741
  • Fax: 919-942-1473
Mailing address:
  • Phone: 919-933-8494
  • Fax: 919-933-9201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: LYDIA FUSE MASON
Title or Position: CFO
Credential:
Phone: 919-933-8494