Provider Demographics
NPI:1144245887
Name:PIEDMONT PRIME CARE
Entity Type:Organization
Organization Name:PIEDMONT PRIME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:COX
Authorized Official - Last Name:SETTLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:434-791-2273
Mailing Address - Street 1:130 ENTERPRISE DRIVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24540-4070
Mailing Address - Country:US
Mailing Address - Phone:434-791-2273
Mailing Address - Fax:434-791-2824
Practice Address - Street 1:130 ENTERPRISE DRIVE
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24540-4070
Practice Address - Country:US
Practice Address - Phone:434-791-2824
Practice Address - Fax:434-791-2824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1972528339Medicaid
VA1248110001Medicare NSC
VA1972528339Medicaid