Provider Demographics
NPI:1598714297
Name:HICKORY ALLERGY AND ASTHMA CLINIC, PA
Entity Type:Organization
Organization Name:HICKORY ALLERGY AND ASTHMA CLINIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:THACHER
Authorized Official - Last Name:INGLEFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-322-1275
Mailing Address - Street 1:220 18TH STREET CIR SE
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-1361
Mailing Address - Country:US
Mailing Address - Phone:828-322-1275
Mailing Address - Fax:828-315-9941
Practice Address - Street 1:220 18TH STREET CIR SE
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-1361
Practice Address - Country:US
Practice Address - Phone:828-322-1275
Practice Address - Fax:828-315-9941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2325262Medicare ID - Type Unspecified