Provider Demographics
NPI:1417180662
Name:INTERNAL MEDICINE &PSYCHIATRIC SERVICES OF THE PIEDMONT
Entity Type:Organization
Organization Name:INTERNAL MEDICINE &PSYCHIATRIC SERVICES OF THE PIEDMONT
Other - Org Name:IMPSP
Other - Org Type:Other Name
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:P
Authorized Official - Last Name:KILLIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-325-0555
Mailing Address - Street 1:PO BOX 1447
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28603-1447
Mailing Address - Country:US
Mailing Address - Phone:828-325-0555
Mailing Address - Fax:828-267-7555
Practice Address - Street 1:929 15TH ST NE
Practice Address - Street 2:SUITE 100
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-4161
Practice Address - Country:US
Practice Address - Phone:828-325-0555
Practice Address - Fax:828-267-7555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-03
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200501179207R00000X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5913662Medicaid
NC022MMOtherBCBS
NC513278OtherMANAGED HEALTH NETWORK
NCDQ4195OtherRAILROAD MEDICARE
NC2046752BMedicare PIN