| Piedmont Psychiatric Service Pa | |
|
2094 Woodruff Rd Greenville SC 29607-5939 | |
| (864) 676-9211 | |
| (864) 676-9432 |
| Full Name | Piedmont Psychiatric Service Pa |
|---|---|
| Speciality | Clinic/Center |
| Location | 2094 Woodruff Rd, Greenville, South Carolina |
| Authorized Official Name and Position | Tony Goodbar (PHYSICIAN) |
| Authorized Official Contact | 8646769211 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Piedmont Psychiatric Service Pa 2094 Woodruff Rd Greenville SC 29607-5939 Ph: (864) 676-9211 | Piedmont Psychiatric Service Pa 2094 Woodruff Rd Greenville SC 29607-5939 Ph: (864) 676-9211 |
| NPI Number | 1164481867 |
|---|---|
| Provider Enumeration Date | 03/21/2006 |
| Last Update Date | 02/03/2011 |
| Medicare PECOS PAC ID | 1355245440 |
|---|---|
| Medicare Enrollment ID | O20031120000785 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164481867 | NPI | - | NPPES |
| GP2107 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | 14711 (South Carolina) | Primary |
| Provider Name | Tony Reid Goodbar |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1588602734 PECOS PAC ID: 1355245390 Enrollment ID: I20031124000512 |
| Provider Name | Jeffrey K Smith |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1932147188 PECOS PAC ID: 3173427119 Enrollment ID: I20110811000498 |
| Provider Name | Ingrid Miller |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1447548672 PECOS PAC ID: 8224208004 Enrollment ID: I20110906000105 |
| Provider Name | Carrie Laxton Ballenger |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275175093 PECOS PAC ID: 1355775487 Enrollment ID: I20191226001733 |
| Provider Name | Zachary Adams |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1093423287 PECOS PAC ID: 5991160111 Enrollment ID: I20230422000230 |
| Provider Name | Michael D Smith |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1669410841 PECOS PAC ID: 7719336346 Enrollment ID: I20231208000055 |
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