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SOUTH PARK MEDICAL CLINIC PA NPI 1083614564


NPI Information

NPI: 1083614564
Provider Name: SOUTH PARK MEDICAL CLINIC PA
Classification: Family Medicine - 207Q00000X
Entity Type: Organization
Address:
133 1ST AVE SE
HICKORY, NC
ZIP 28602
Phone: (828) 322-5915
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SOUTH PARK MEDICAL CLINIC PA is a family medicine in Hickory, NC. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. SOUTH PARK MEDICAL CLINIC PA NPI is 1083614564. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

133 1ST AVE SE
HICKORY, NC
ZIP 28602-005
Phone: (828) 322-5915
Fax: (828) 345-0387

The provider's authorized official is Elbert Andrew Rudisill .
The authorized official title is President and has the following contact phone number (828) 322-5915.

The enumeration date for this NPI number is 7/27/2005 and was last updated on 8/22/2020.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207Q00000XFamily Medicine21863NORTH CAROLINAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
18902716MEDICAIDNORTH CAROLINA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.