Provider Demographics
NPI:1457382483
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?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC417282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC500041Medicaid
420002OtherBCBS SOUTH CAROLINA
000442OtherHUMANA
SC290038Medicaid
420002B000000OtherSECTION 1011
510521420OtherAETNA US HEALTHCARE (NATI
SC434803Medicaid
SCGP2060Medicaid
SC290038Medicaid