Provider Demographics
NPI:1689673279
Name:PIEDMONT NEPHROLOGY & HYPERTENSION ASSOCIATES, PA
Entity Type:Organization
Organization Name:PIEDMONT NEPHROLOGY & HYPERTENSION ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-327-7788
Mailing Address - Street 1:1899 TATE BLVD SE
Mailing Address - Street 2:SUITE 2101
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-4200
Mailing Address - Country:US
Mailing Address - Phone:828-327-7788
Mailing Address - Fax:828-327-0112
Practice Address - Street 1:1899 TATE BLVD SE
Practice Address - Street 2:SUITE 2101
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-4200
Practice Address - Country:US
Practice Address - Phone:828-327-7788
Practice Address - Fax:828-327-0112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-18
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC32718174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8940515Medicaid
NC8940515Medicaid
NC207090BMedicare ID - Type UnspecifiedMEDICARE