NPIMap

Organization Active NPI

Piedmont Gynecological and Obstetrical Associates

  • Obstetrics & Gynecology Physician
  • Fort Mill, SC
National Provider Identifier
1497788079
Registry record updated Nov 28, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
Legal business name
PIEDMONT GYNECOLOGICAL AND OBSTETRICAL ASSOCIATES
Practice address
704 Gold Hill Road
Ste 215
Fort Mill, SC 29715-8907
Phone
(803) 835-0434
Fax
(704) 512-2731
NPI assigned
Jul 8, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 28, 2012

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

Authorized official

Name
Daniel L Wiens
Title
Senior Vice President
Phone
(704) 355-0648

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207V00000X Primary

Addresses

Primary practice location

704 Gold Hill Road
Ste 215
Fort Mill, SC 29715-8907

Mailing address

PO Box 601067
Charlotte, NC 28260-1067
Phone (803) 835-0434

Other identifiers 3

IdentifierTypeStateIssuer
PA6136MedicaidSC
89013AHMedicaidNC
89013AJMedicaidNC

National Provider Directory

National Provider Directory

Locations

704 Gold Hill Rd
Ste 215
Fort Mill, SC 29715
Phone (803) 835-0434

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1152316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1354060800000",
    "number": "1497788079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 601067",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282601067",
            "telephone_number": "803-835-0434",
            "fax_number": "704-512-2731"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "704 GOLD HILL ROAD",
            "address_2": "STE 215",
            "city": "FORT MILL",
            "state": "SC",
            "postal_code": "297158907",
            "telephone_number": "803-835-0434",
            "fax_number": "704-512-2731"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PIEDMONT GYNECOLOGICAL AND OBSTETRICAL ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-08",
        "last_updated": "2012-11-28",
        "status": "A",
        "authorized_official_last_name": "WIENS",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "SENIOR VICE PRESIDENT",
        "authorized_official_telephone_number": "704-355-0648"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PA6136",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89013AH",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89013AJ",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Nov 28, 2012; 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.