Provider Demographics
NPI:1700973096
Name:HICKS GROUP INC
Entity Type:Organization
Organization Name:HICKS GROUP INC
Other - Org Name:THE MEDICINE MART
Other - Org Type:Other Name
Authorized Official - Title/Position:CORP OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:MCGILL
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:803-649-7437
Mailing Address - Street 1:1020 RICHLAND AVE W
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29801-3224
Mailing Address - Country:US
Mailing Address - Phone:803-649-7437
Mailing Address - Fax:803-649-2062
Practice Address - Street 1:1020 RICHLAND AVE W
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801-3224
Practice Address - Country:US
Practice Address - Phone:803-649-7437
Practice Address - Fax:803-649-2062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC50008778332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC620607Medicaid
SC0494620001Medicare NSC