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General NPI Number Information
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NPI Number | 1790029015
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Entity Type | Organization
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Legal Business Name | PIEDMONT CAROLINA VASCULAR SURGERY, LLC
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Dates
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Enumeration Date | 11/27/2012
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Last Update Date | 06/16/2016
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Provider Practice Location Address
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Address Line | 1721 EBENEZER RD SUITE 115
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City | ROCK HILL
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State | SC
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Zip | 29732-4103
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Country | US
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Telephone | 803-985-4000
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Fax | 803-985-4006
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Provider Business Mailing Address
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Address Line | 1721 EBENEZER RD SUITE 115
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City | ROCK HILL
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State | SC
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Zip | 29732-4103
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Country | US
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Telephone | 803-985-4000
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Fax | 803-985-4006
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Authorized Official
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Title or Position | VP OF OUTPATIENT SERVICES, TENET
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Name | MR. MICHAEL K BURTNETT
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Credential |
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Telephone | 469-893-2902
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number |
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License Number State |
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