Provider Demographics
NPI:1083676928
Name:HICKORY CARDIOLOGY ASSOCIATES PLLC
Entity Type:Organization
Organization Name:HICKORY CARDIOLOGY ASSOCIATES PLLC
Other - Org Name:WESTERN PIEDMONT HEART CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:NORMAN
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-324-4804
Mailing Address - Street 1:1771 TATE BLVD SE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-4249
Mailing Address - Country:US
Mailing Address - Phone:828-324-4804
Mailing Address - Fax:828-324-0525
Practice Address - Street 1:1771 TATE BLVD SE
Practice Address - Street 2:SUITE 201
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-4249
Practice Address - Country:US
Practice Address - Phone:828-324-4804
Practice Address - Fax:828-324-0525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-05
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC84907207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8901853Medicaid
NC01853OtherBCBS OF NC GROUP NUMBER
NC8901853Medicaid