MEDICARE: PIEDMONT HEALTH 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	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1144583055
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PIEDMONT HEALTH SERVICES, INC.

Provider Business Mailing Address
First Line	:	299 LLOYD ST
Second Line	:
City	:	CARRBORO
State	:	NC
Zip	:	27510-1821
Country	:	US
Telephone Number	:	919-933-8494
Fax Number	:	919-933-9201

Provider Business Practice Location Address
First Line	:	7718 SYLVAN RD
Second Line	:
City	:	SNOW CAMP
State	:	NC
Zip	:	27349-9504
Country	:	US
Telephone Number	:	336-506-0631
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	BRIAN TOOMEY
Credential	:
Telephone Number	:	919-933-8494

Provider Enumeration Date	:	06/18/2012
Last Update Date	:	06/18/2012

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