Provider Demographics
NPI:1811325863
Name:LINDA L HICE
Entity type:Organization
Organization Name:LINDA L HICE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:HICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-482-9938
Mailing Address - Street 1:1100 S LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28152-6708
Mailing Address - Country:US
Mailing Address - Phone:704-482-9938
Mailing Address - Fax:704-600-6433
Practice Address - Street 1:1100 S LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28152-6708
Practice Address - Country:US
Practice Address - Phone:704-482-9938
Practice Address - Fax:704-600-6433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-29
Last Update Date:2015-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCFM00159332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7795304Medicaid
NC1487690004OtherINDIVIDUAL NPI
NC7795304Medicaid