Provider Demographics
NPI:1508959420
Name:NEONATOLOGY SERVICES OF HICKORY, PLLC
Entity Type:Organization
Organization Name:NEONATOLOGY SERVICES OF HICKORY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:S
Authorized Official - Last Name:HARVEY
Authorized Official - Suffix:
Authorized Official - Credentials:CRT/RCP
Authorized Official - Phone:866-848-4296
Mailing Address - Street 1:PO BOX 1780
Mailing Address - Street 2:
Mailing Address - City:GLEN SAINT MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32040-1780
Mailing Address - Country:US
Mailing Address - Phone:866-848-4296
Mailing Address - Fax:800-515-1295
Practice Address - Street 1:352 2ND ST. NW
Practice Address - Street 2:SUITE #205
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601
Practice Address - Country:US
Practice Address - Phone:828-345-0877
Practice Address - Fax:828-345-0514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2010-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC118704OtherNC LICENSE NUMBER
NC891349WMedicaid
NC891349WMedicaid