Provider Demographics
NPI:1922004852
Name:PIEDMONT PATHOLOGY ASSOCIATES INC
Entity Type:Organization
Organization Name:PIEDMONT PATHOLOGY ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:S
Authorized Official - Last Name:MATHIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-322-3821
Mailing Address - Street 1:1899 TATE BLVD SE
Mailing Address - Street 2:STE 1105
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-4200
Mailing Address - Country:US
Mailing Address - Phone:828-322-3821
Mailing Address - Fax:828-322-6697
Practice Address - Street 1:1899 TATE BLVD SE
Practice Address - Street 2:STE 1105
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-4200
Practice Address - Country:US
Practice Address - Phone:828-322-3821
Practice Address - Fax:828-322-6697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-24
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207ZP0102X, 291U00000X
NC21248293D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
No291U00000XLaboratoriesClinical Medical Laboratory
No293D00000XLaboratoriesPhysiological LaboratoryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC02415OtherBCBS
NC8902415Medicaid
NC02415OtherBCBS
NCC82414Medicare UPIN
NCG05710Medicare UPIN
NCC86991Medicare UPIN
NCF49497Medicare UPIN
NCD92889Medicare UPIN
NC255059Medicare ID - Type UnspecifiedNC MEDICARE
NC204227Medicare ID - Type UnspecifiedNC MEDICARE
NCC82416Medicare UPIN
NC8902415Medicaid