MEDICARE: PIEDMONT PATHOLOGY ASSOCIATES 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	291U00000X	Clinical Medical Laboratory
2	293D00000X	Physiological Laboratory	21248	NC
3	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	02415	OTHER	NC	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922004852
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PIEDMONT PATHOLOGY ASSOCIATES INC

Provider Business Mailing Address
First Line	:	1899 TATE BLVD SE
Second Line	:	STE 1105
City	:	HICKORY
State	:	NC
Zip	:	28602-4200
Country	:	US
Telephone Number	:	828-322-3821
Fax Number	:	828-322-6697

Provider Business Practice Location Address
First Line	:	1899 TATE BLVD SE
Second Line	:	STE 1105
City	:	HICKORY
State	:	NC
Zip	:	28602-4200
Country	:	US
Telephone Number	:	828-322-3821
Fax Number	:	828-322-6697

Authorized Official
Title or Position	:	BUSINESS ADMINISTRATOR
Name	:	KAREN S MATHIS
Credential	:
Telephone Number	:	828-322-3821

Provider Enumeration Date	:	06/24/2005
Last Update Date	:	08/18/2021

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