Healthcare Provider Details

I. General information

NPI: 1023402732
Provider Name (Legal Business Name): IREDELL PHYSICIAN NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2015
Last Update Date: 04/05/2021
Certification Date: 04/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1375 4TH STREET DR NW
HICKORY NC
28601-2523
US

IV. Provider business mailing address

PO BOX 896199
CHARLOTTE NC
28289-6199
US

V. Phone/Fax

Practice location:
  • Phone: 704-954-8277
  • Fax: 704-954-8199
Mailing address:
  • Phone: 833-936-1364
  • Fax: 704-954-8199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number9500409
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: SKIP SMITH
Title or Position: CFO
Credential:
Phone: 704-873-5661