Provider Demographics
NPI:1578772976
Name:FAMILY MEDICINE & PSYCHIATRY OF THE CAROLINAS AT ROCK HILL PC
Entity Type:Organization
Organization Name:FAMILY MEDICINE & PSYCHIATRY OF THE CAROLINAS AT ROCK HILL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:N
Authorized Official - Last Name:PISTONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-324-7792
Mailing Address - Street 1:1420 EBENEZER RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-2743
Mailing Address - Country:US
Mailing Address - Phone:803-324-7792
Mailing Address - Fax:803-981-7792
Practice Address - Street 1:1420 EBENEZER RD
Practice Address - Street 2:SUITE 105
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-2743
Practice Address - Country:US
Practice Address - Phone:803-324-7792
Practice Address - Fax:803-981-7792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2837101YP2500X
SC69041041C0700X
SC2600106H00000X
SC268582084P0015X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Not Answered2084P0015XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychosomatic MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5903330Medicaid
SCGP4324Medicaid
SCG41249Medicare UPIN
NC5903330Medicaid