Provider Demographics
NPI:1124199773
Name:PIEDMONT ARTHRITIS CLINIC PA
Entity Type:Organization
Organization Name:PIEDMONT ARTHRITIS CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:JH
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-527-2330
Mailing Address - Street 1:3 SAINT FRANCIS DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-3971
Mailing Address - Country:US
Mailing Address - Phone:864-235-8396
Mailing Address - Fax:864-527-2360
Practice Address - Street 1:3 SAINT FRANCIS DR
Practice Address - Street 2:SUITE 400
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-3971
Practice Address - Country:US
Practice Address - Phone:864-235-8396
Practice Address - Fax:864-527-2360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPA3102Medicaid
SCPA3102Medicaid