Provider Demographics
NPI:1053403873
Name:PIEDMONT INFECTIOUS DISEASE CONSULTANTS P A
Entity type:Organization
Organization Name:PIEDMONT INFECTIOUS DISEASE CONSULTANTS P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:M
Authorized Official - Last Name:AUTEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-304-4935
Mailing Address - Street 1:1985 TATE BLVD., SE
Mailing Address - Street 2:FIRST PLAZA BLDG., STE 720
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-1433
Mailing Address - Country:US
Mailing Address - Phone:828-304-4935
Mailing Address - Fax:
Practice Address - Street 1:1985 TATE BLVD., SE
Practice Address - Street 2:FIRST PLAZA BLDG., STE 720
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-1433
Practice Address - Country:US
Practice Address - Phone:828-304-4935
Practice Address - Fax:828-304-4936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9900415174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC790190GMedicaid
NC2344036Medicare ID - Type Unspecified
NCE67362Medicare UPIN
NCF96508Medicare UPIN