Provider Demographics
NPI:1932134384
Name:AMISUB OF SOUTH CAROLINA, INC.
Entity Type:Organization
Organization Name:AMISUB OF SOUTH CAROLINA, INC.
Other - Org Name:PIEDMONT MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:GILMORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-329-6829
Mailing Address - Street 1:PO BOX 740772
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-0772
Mailing Address - Country:US
Mailing Address - Phone:803-329-6730
Mailing Address - Fax:919-774-2295
Practice Address - Street 1:222 S HERLONG AVE
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-1158
Practice Address - Country:US
Practice Address - Phone:803-329-1234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMISUB OF SOUTH CAROLINA, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-12
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC417273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
42-S002Medicare PIN