Provider Demographics
NPI:1699036913
Name:PIEDMONT INFUSION SERVICES, INC
Entity Type:Organization
Organization Name:PIEDMONT INFUSION SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:BETHEL
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:RPH
Authorized Official - Phone:434-792-6387
Mailing Address - Street 1:111 MALL DR
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24540-4069
Mailing Address - Country:US
Mailing Address - Phone:434-792-6387
Mailing Address - Fax:434-792-6389
Practice Address - Street 1:111 MALL DR
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24540-4069
Practice Address - Country:US
Practice Address - Phone:434-792-6387
Practice Address - Fax:434-792-6389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-04
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0201004278261QI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1023253895Medicaid
VA1285879049Medicaid
VAQ415740001OtherMEDICARE PTAN