NPIMap

Organization Active NPI

Piedmont Carolina Vascular Surgery, LLC

  • Vascular Surgery Physician
  • Rock Hill, SC
National Provider Identifier
1790029015
Registry record updated Jun 16, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
Legal business name
PIEDMONT CAROLINA VASCULAR SURGERY, LLC
Practice address
1721 Ebenezer Rd
Suite 115
Rock Hill, SC 29732-4103
Phone
(803) 985-4000
Fax
(803) 985-4006
NPI assigned
Nov 27, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2016

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

Authorized official

Name
Mr. Michael K Burtnett
Title
VP of Outpatient Services, Tenet
Phone
(469) 893-2902

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2086S0129X Primary

Addresses

Primary practice location

1721 Ebenezer Rd
Suite 115
Rock Hill, SC 29732-4103

Mailing address

1721 Ebenezer Rd
Suite 115
Rock Hill, SC 29732-4103
Phone (803) 985-4000

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

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": "1353974400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1466035200000",
    "number": "1790029015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1721 EBENEZER RD",
            "address_2": "SUITE 115",
            "city": "ROCK HILL",
            "state": "SC",
            "postal_code": "297324103",
            "telephone_number": "803-985-4000",
            "fax_number": "803-985-4006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1721 EBENEZER RD",
            "address_2": "SUITE 115",
            "city": "ROCK HILL",
            "state": "SC",
            "postal_code": "297324103",
            "telephone_number": "803-985-4000",
            "fax_number": "803-985-4006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PIEDMONT CAROLINA VASCULAR SURGERY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-27",
        "last_updated": "2016-06-16",
        "status": "A",
        "authorized_official_last_name": "BURTNETT",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "VP OF OUTPATIENT SERVICES, TENET",
        "authorized_official_telephone_number": "469-893-2902",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery, Vascular Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rock Hill, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 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.