Provider Demographics
NPI: | 1619292109 |
---|---|
Name: | HILL, NATHAN C (PA) |
Entity Type: | Individual |
Prefix: | |
First Name: | NATHAN |
Middle Name: | C |
Last Name: | HILL |
Suffix: | |
Gender: | M |
Credentials: | PA |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 2165 MEDICAL PARK DR |
Mailing Address - Street 2: | |
Mailing Address - City: | HICKORY |
Mailing Address - State: | NC |
Mailing Address - Zip Code: | 28602-8809 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 828-324-2800 |
Mailing Address - Fax: | 828-294-9141 |
Practice Address - Street 1: | 2165 MEDICAL PARK DR |
Practice Address - Street 2: | |
Practice Address - City: | HICKORY |
Practice Address - State: | NC |
Practice Address - Zip Code: | 28602-8809 |
Practice Address - Country: | US |
Practice Address - Phone: | 828-324-2800 |
Practice Address - Fax: | 828-294-9141 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2010-03-29 |
Last Update Date: | 2016-07-11 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
OH | 50.003041 | 363AS0400X |
NC | 0010-06567 | 363A00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | |
No | 363AS0400X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
OH | 0068951 | Medicaid | |
PA83901 | Medicare PIN |