Provider Demographics
NPI:1437208790
Name:PIEDMONT FAMILY PRACTICE LLC
Entity Type:Organization
Organization Name:PIEDMONT FAMILY PRACTICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:LINDSAY
Authorized Official - Last Name:SLOAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-845-3331
Mailing Address - Street 1:115 BEATTIE PARK RD
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:SC
Mailing Address - Zip Code:29673-1410
Mailing Address - Country:US
Mailing Address - Phone:864-845-3331
Mailing Address - Fax:864-845-7078
Practice Address - Street 1:115 BEATTIE PARK RD
Practice Address - Street 2:
Practice Address - City:PIEDMONT
Practice Address - State:SC
Practice Address - Zip Code:29673-1410
Practice Address - Country:US
Practice Address - Phone:864-845-3331
Practice Address - Fax:864-845-7078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2018-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3020Medicaid
SC8157Medicare PIN