MEDICARE: HICKORY INTERNAL MEDICINE, HYPERTENSION & RENAL ASSOCIATES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	173000000X	Legal Medicine	35141	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235125378
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HICKORY INTERNAL MEDICINE, HYPERTENSION & RENAL ASSOCIATES

Provider Business Mailing Address
First Line	:	50 13TH AVE NE
Second Line	:	SUITE 2A
City	:	HICKORY
State	:	NC
Zip	:	28601-3748
Country	:	US
Telephone Number	:	828-322-3541
Fax Number	:	828-324-7862

Provider Business Practice Location Address
First Line	:	50 13TH AVE NE
Second Line	:	SUITE 2A
City	:	HICKORY
State	:	NC
Zip	:	28601-3748
Country	:	US
Telephone Number	:	828-322-3541
Fax Number	:	828-324-7862

Authorized Official
Title or Position	:	CEO
Name	:	DR. HENRY IGDAL
Credential	:	MD
Telephone Number	:	828-322-3541

Provider Enumeration Date	:	09/23/2005
Last Update Date	:	08/22/2020

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