Healthcare Provider Details

I. General information

NPI: 1417180662
Provider Name (Legal Business Name): INTERNAL MEDICINE &PSYCHIATRIC SERVICES OF THE PIEDMONT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2009
Last Update Date: 06/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

929 15TH ST NE SUITE 100
HICKORY NC
28601-4161
US

IV. Provider business mailing address

PO BOX 1447
HICKORY NC
28603-1447
US

V. Phone/Fax

Practice location:
  • Phone: 828-325-0555
  • Fax: 828-267-7555
Mailing address:
  • Phone: 828-325-0555
  • Fax: 828-267-7555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number200501179
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number200501179
License Number StateNC

VIII. Authorized Official

Name: MRS. TERESA P KILLIAN
Title or Position: PRACTICE MANAGER
Credential:
Phone: 828-325-0555