Healthcare Provider Details

I. General information

NPI: 1255353298
Provider Name (Legal Business Name): PORT CITY ORTHOPAEDICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 07/24/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 CAUSEWAY DR UNIT 232
WRIGHTSVILLE BEACH NC
28480-1759
US

IV. Provider business mailing address

CO D HICKEY, PRESIDENT 6101 OLD BRANCH RD
WILMINGTON NC
28409
US

V. Phone/Fax

Practice location:
  • Phone: 910-791-4492
  • Fax: --
Mailing address:
  • Phone: 910-791-4492
  • Fax: --

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DERRICK GERARD HICKEY
Title or Position: PRESIDENT
Credential: MD
Phone: 910-791-4492