Basic Information
| Provider Information | |||||||||
| NPI: | 1083676928 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HICKORY CARDIOLOGY ASSOCIATES PLLC | ||||||||
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| OtherOrganizationName: | WESTERN PIEDMONT HEART CENTERS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1771 TATE BLVD SE | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | HICKORY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286024249 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8283244804 | ||||||||
| FaxNumber: | 8283240525 | ||||||||
| Practice Location | |||||||||
| Address1: | 1771 TATE BLVD SE | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | HICKORY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286024249 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8283244804 | ||||||||
| FaxNumber: | 8283240525 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2006 | ||||||||
| LastUpdateDate: | 11/05/2008 | ||||||||
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| AuthorizedOfficialLastName: | MCDONALD | ||||||||
| AuthorizedOfficialFirstName: | RALPH | ||||||||
| AuthorizedOfficialMiddleName: | NORMAN | ||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DOCTOR | ||||||||
| AuthorizedOfficialTelephone: | 8283244804 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 84907 | NC | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 8901853 | 05 | NC | MEDICAID | 01853 | 01 | NC | BCBS OF NC GROUP NUMBER | OTHER |