Provider Demographics
NPI:1043398209
Name:FOOTHILLS INTERNAL MEDICINE
Entity Type:Organization
Organization Name:FOOTHILLS INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRANDI
Authorized Official - Middle Name:SHAW
Authorized Official - Last Name:GUARINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-322-3898
Mailing Address - Street 1:1321 N CENTER ST
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-2535
Mailing Address - Country:US
Mailing Address - Phone:828-322-3898
Mailing Address - Fax:
Practice Address - Street 1:1321 N CENTER ST
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-2535
Practice Address - Country:US
Practice Address - Phone:828-322-3898
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21863207Q00000X
NC9900062207R00000X
NC101975363A00000X
NC207R00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC017TNOtherBCBS
NC2344801Medicare ID - Type Unspecified