Provider Demographics
NPI:1003075599
Name:HICKORY PLASTIC SURGERY CENTER
Entity Type:Organization
Organization Name:HICKORY PLASTIC SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:SICILIANO
Authorized Official - Suffix:
Authorized Official - Credentials:MC
Authorized Official - Phone:828-322-8380
Mailing Address - Street 1:50 13TH AVE NE
Mailing Address - Street 2:SUITE 2-B
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-3764
Mailing Address - Country:US
Mailing Address - Phone:828-322-8380
Mailing Address - Fax:828-328-4967
Practice Address - Street 1:50 13TH AVE NE
Practice Address - Street 2:SUITE 2-B
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-3764
Practice Address - Country:US
Practice Address - Phone:828-322-8380
Practice Address - Fax:828-328-4967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-09
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC220800887208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC203208Medicare PIN
NC2189129Medicare PIN