Provider Demographics
NPI:1114403342
Name:PIEDMONT CARE, INC.
Entity Type:Organization
Organization Name:PIEDMONT CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-582-7773
Mailing Address - Street 1:101 N PINE ST STE 200
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29302-1604
Mailing Address - Country:US
Mailing Address - Phone:864-582-7773
Mailing Address - Fax:864-582-8637
Practice Address - Street 1:101 N PINE ST STE 200
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29302-1604
Practice Address - Country:US
Practice Address - Phone:864-582-7773
Practice Address - Fax:864-582-8637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-11
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty