NPIMap

Organization Active NPI

Piedmont Family Practice at Tega Cay, LLC

Doing business as Piedmont Family Practice at Tega Cay

  • Family Medicine Physician
  • Fort Mill, SC
National Provider Identifier
1407863343
Registry record updated Jun 23, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
PIEDMONT FAMILY PRACTICE AT TEGA CAY, LLC
Doing business as
Piedmont Family Practice at Tega Cay
Practice address
773 Stockbridge Drive
Fort Mill, SC 29708
Phone
(803) 802-2424
Fax
(803) 802-3767
NPI assigned
Aug 2, 2006
Last updated
Jun 23, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Wesley O. James
Title
Regional Cfo, Tenet
Phone
(404) 265-5009

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

773 Stockbridge Drive
Fort Mill, SC 29708

Mailing address

773 Stockbridge Drive
Fort Mill, SC 29708
Phone (803) 802-2424

Other identifiers 2

IdentifierTypeStateIssuer
GP4723MedicaidSC
DO0992OtherSCRAILROAD MEDICARE PTAN NUMBER

Other names 1

  • Piedmont Family Practice at Tega Cay Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154476800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1466640000000",
    "number": "1407863343",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "773 STOCKBRIDGE DRIVE",
            "city": "FORT MILL",
            "state": "SC",
            "postal_code": "29708",
            "telephone_number": "803-802-2424",
            "fax_number": "803-802-3767"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "773 STOCKBRIDGE DRIVE",
            "city": "FORT MILL",
            "state": "SC",
            "postal_code": "29708",
            "telephone_number": "803-802-2424",
            "fax_number": "803-802-3767"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PIEDMONT FAMILY PRACTICE AT TEGA CAY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-02",
        "last_updated": "2016-06-23",
        "status": "A",
        "authorized_official_last_name": "JAMES",
        "authorized_official_first_name": "WESLEY",
        "authorized_official_middle_name": "O.",
        "authorized_official_title_or_position": "REGIONAL CFO, TENET",
        "authorized_official_telephone_number": "404-265-5009",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP4723",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE PTAN NUMBER",
            "identifier": "DO0992",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Piedmont Family Practice at Tega Cay",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Mill, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.