Provider Demographics
NPI:1730122573
Name:PIEDMONT JOINT VENTURE LABORATORY, INC.
Entity Type:Organization
Organization Name:PIEDMONT JOINT VENTURE LABORATORY, INC.
Other - Org Name:PIEDMONT MEDICAL LABORATORY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DOUGHERTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-222-2313
Mailing Address - Street 1:333 W CORK ST
Mailing Address - Street 2:SUITE 215
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-3871
Mailing Address - Country:US
Mailing Address - Phone:540-536-5500
Mailing Address - Fax:540-665-4162
Practice Address - Street 1:333 W CORK ST
Practice Address - Street 2:SUITE 215
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-3870
Practice Address - Country:US
Practice Address - Phone:540-536-5500
Practice Address - Fax:540-665-4162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA77885OtherSENTARA PROVIDER NUMBER
VA234867OtherMAMSI PROVIDER NUMBER
VT0037433000Medicaid
VA383117OtherANTHEM PROVIDER NUMBER
VAE4981219Medicaid
VA690000009Medicare ID - Type Unspecified