Provider Demographics
NPI:1760439483
Name:PIEDMONT INTERNAL MEDICINE, INC
Entity Type:Organization
Organization Name:PIEDMONT INTERNAL MEDICINE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VICKIE
Authorized Official - Middle Name:E
Authorized Official - Last Name:MOSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-791-1345
Mailing Address - Street 1:125 EXECUTIVE DR
Mailing Address - Street 2:SUITE H
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541-4155
Mailing Address - Country:US
Mailing Address - Phone:434-791-1345
Mailing Address - Fax:
Practice Address - Street 1:125 EXECUTIVE DR
Practice Address - Street 2:SUITE H
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-4155
Practice Address - Country:US
Practice Address - Phone:434-791-1345
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC10394OtherMEDICARE GROUP
VA006237OtherANTHEM GROUP NUMBER
NC8901421Medicaid