Provider Demographics
NPI:1508059213
Name:PIEDMONT HEALTHCARE FOR WOMEN, P.A.
Entity Type:Organization
Organization Name:PIEDMONT HEALTHCARE FOR WOMEN, P.A.
Other - Org Name:GREEN VALLEY OBSTETRICS, GYNECOLOGY & INFERTILITY, P. A.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-378-1110
Mailing Address - Street 1:719 GREEN VALLEY RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-7014
Mailing Address - Country:US
Mailing Address - Phone:336-378-1110
Mailing Address - Fax:336-378-9986
Practice Address - Street 1:719 GREEN VALLEY RD
Practice Address - Street 2:SUITE 201
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-7014
Practice Address - Country:US
Practice Address - Phone:336-378-1110
Practice Address - Fax:336-378-9986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-26
Last Update Date:2007-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89014FVMedicaid
NC2330745CMedicare PIN