South Park Medical Clinic Pa

LBN: South Park Medical Clinic Pa
South Park Medical Clinic Pa is an health care organization with primary practice located at 133 1St Ave Se , Hickory NC 28602-3005. The organization recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as the primary health care specialty. South Park Medical Clinic Pa can be contacted via phone (828) 322-5915, or through Rudisill, Elbert Andrew via phone (828) 322-5915.

Contact Information

Primary practice address
133 1St Ave Se Hickory NC 28602-3005
Phone: (828) 322-5915
Fax: (828) 345-0387
Website:
Map and Directions
Authorized official contact:
Name: Rudisill, Elbert Andrew Doctor of Medicine (MD)
Phone: (828) 322-5915

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 21863 North Carolina

Profile Details

NPI number 1083614564
LBN Legal business name South Park Medical Clinic Pa
DBA Doing business as
Authorized official Rudisill, Elbert Andrew Doctor of Medicine (MD)
Entity Organization
Organization subpart 1 No
Enumeration date Jul 27th, 2005
Last updated Aug 22nd, 2020 - about 4 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

Request for update

Identifiers

StateTypeNumberIssuer
All States NPI 1083614564 NPPES
North Carolina MEDICAID 8902716

Popular Providers