Provider Demographics
NPI:1811999154
Name:PIEDMONT SATELLITE SERVICE CENTER INC
Entity type:Organization
Organization Name:PIEDMONT SATELLITE SERVICE CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PENNY
Authorized Official - Middle Name:ANNETT
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-449-7357
Mailing Address - Street 1:PO BOX 376
Mailing Address - Street 2:
Mailing Address - City:GIBSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27249-0376
Mailing Address - Country:US
Mailing Address - Phone:336-449-7357
Mailing Address - Fax:336-449-7592
Practice Address - Street 1:1230 SPRINGWOOD CHURCH ROAD
Practice Address - Street 2:
Practice Address - City:GIBSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:27249-2646
Practice Address - Country:US
Practice Address - Phone:336-449-7357
Practice Address - Fax:336-449-7592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-01
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7700387Medicaid
NC0175670001Medicare ID - Type UnspecifiedMEDICARE PROVIDER NO.