Provider Demographics
NPI:1154506699
Name:HIDA CLINIC, LLC
Entity Type:Organization
Organization Name:HIDA CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE ORGANIZER
Authorized Official - Prefix:DR
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:TATUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-644-5573
Mailing Address - Street 1:1939 SHOAL CREEK RD
Mailing Address - Street 2:
Mailing Address - City:MURPHY
Mailing Address - State:NC
Mailing Address - Zip Code:28906-8480
Mailing Address - Country:US
Mailing Address - Phone:828-494-7157
Mailing Address - Fax:
Practice Address - Street 1:1939 SHOAL CREEK RD
Practice Address - Street 2:
Practice Address - City:MURPHY
Practice Address - State:NC
Practice Address - Zip Code:28906-8480
Practice Address - Country:US
Practice Address - Phone:828-644-5573
Practice Address - Fax:828-644-5562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-03
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2007-00088261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care