Provider Demographics
NPI:1952554461
Name:PIEDMONT SPINE AND NEUROSURGICAL GROUP, P.A.
Entity Type:Organization
Organization Name:PIEDMONT SPINE AND NEUROSURGICAL GROUP, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:N
Authorized Official - Last Name:BUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:864-224-5700
Mailing Address - Street 1:109 MONTGOMERY DR
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-3333
Mailing Address - Country:US
Mailing Address - Phone:864-224-5700
Mailing Address - Fax:864-226-0680
Practice Address - Street 1:3 SAINT FRANCIS DR STE 330
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-3972
Practice Address - Country:US
Practice Address - Phone:864-220-4263
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PIEDMONT SPINE AND NEUROSURGICAL GROUP, P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-28
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC14321207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCMPA967Medicaid
SCMPA967Medicaid