Basic Information
| Provider Information | |||||||||
| NPI: | 1629351580 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CATAWBA VALLEY MEDICAL GROUP, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 810 FAIRGROVE CHURCH RD | ||||||||
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| City: | HICKORY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286029617 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8283263809 | ||||||||
| FaxNumber: | 8283263371 | ||||||||
| Practice Location | |||||||||
| Address1: | 810 FAIRGROVE CHURCH RD | ||||||||
| Address2: | |||||||||
| City: | HICKORY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286029617 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8283263809 | ||||||||
| FaxNumber: | 8283263371 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2011 | ||||||||
| LastUpdateDate: | 05/03/2012 | ||||||||
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| AuthorizedOfficialLastName: | BOONE | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | SR VP OF FINANCE/CFO | ||||||||
| AuthorizedOfficialTelephone: | 8283263809 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | CATAWBA VALLEY MEDICAL CENTER | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.