Basic Information
| Provider Information | |||||||||
| NPI: | 1801822523 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PIEDMONT EMERGENCY MEDICAL ASSOCIATES, PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3101 LATROBE DR | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282114849 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7043767362 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3101 LATROBE DR | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282114849 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7043767362 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2006 | ||||||||
| LastUpdateDate: | 01/15/2008 | ||||||||
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| AuthorizedOfficialLastName: | FRYE | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | TREASURER | ||||||||
| AuthorizedOfficialTelephone: | 7043767362 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | QPB915 | 05 | SC | MEDICAID | NPB156 | 05 | SC | MEDICAID | NPB158 | 05 | SC | MEDICAID | 5902564 | 05 | NC | MEDICAID | NPB157 | 05 | SC | MEDICAID | 89013WM | 05 | NC | MEDICAID | 890231H | 05 | NC | MEDICAID | 89013WN | 05 | NC | MEDICAID | NPB155 | 05 | SC | MEDICAID | 5903217 | 05 | NC | MEDICAID |