Provider Demographics
NPI:1558459602
Name:PIEDMONT ENDOCRINOLOGY, PA
Entity Type:Organization
Organization Name:PIEDMONT ENDOCRINOLOGY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:G
Authorized Official - Last Name:STAINES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-322-7338
Mailing Address - Street 1:311 9TH AVENUE DR NE
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-3829
Mailing Address - Country:US
Mailing Address - Phone:828-322-7338
Mailing Address - Fax:828-304-6319
Practice Address - Street 1:311 9TH AVENUE DR NE
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-3829
Practice Address - Country:US
Practice Address - Phone:828-322-7338
Practice Address - Fax:828-304-6319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC207RE0101X207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0236HOtherBCBS OF NC
NC890236HMedicaid
NC0236HOtherBCBS OF NC