Provider Demographics
NPI:1912073362
Name:HICKORY INTERNAL MEDICINE, HYPERTENSION & RENAL ASSOCIATES
Entity Type:Organization
Organization Name:HICKORY INTERNAL MEDICINE, HYPERTENSION & RENAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:A
Authorized Official - Last Name:GENSHEIMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-322-3541
Mailing Address - Street 1:401 MULBERRY ST SW
Mailing Address - Street 2:SUITE 105
Mailing Address - City:LENOIR
Mailing Address - State:NC
Mailing Address - Zip Code:28645-5463
Mailing Address - Country:US
Mailing Address - Phone:828-322-3541
Mailing Address - Fax:828-324-7862
Practice Address - Street 1:50 13TH AVE NE
Practice Address - Street 2:SUITE 2A
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-3748
Practice Address - Country:US
Practice Address - Phone:828-322-2541
Practice Address - Fax:828-324-7862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC35141207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890163YMedicaid
NC890163YMedicaid
NCE82161Medicare UPIN