Healthcare Provider Details

I. General information

NPI: 1912073362
Provider Name (Legal Business Name): HICKORY INTERNAL MEDICINE, HYPERTENSION & RENAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 13TH AVE NE SUITE 2A
HICKORY NC
28601-3748
US

IV. Provider business mailing address

401 MULBERRY ST SW SUITE 105
LENOIR NC
28645-5463
US

V. Phone/Fax

Practice location:
  • Phone: 828-322-2541
  • Fax: 828-324-7862
Mailing address:
  • Phone: 828-322-3541
  • Fax: 828-324-7862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number35141
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier890163Y
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer

VIII. Authorized Official

Name: LINDA A GENSHEIMER
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 828-322-3541