Provider Demographics
NPI:1952785214
Name:CATAWBA VALLEY MEDICAL GROUP,INC
Entity Type:Organization
Organization Name:CATAWBA VALLEY MEDICAL GROUP,INC
Other - Org Name:CATAWBA VALLEY FAMILY MEDICINE-SANDY RIDGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR VP OF FINANCE/CFO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JON
Authorized Official - Last Name:BOONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-326-3809
Mailing Address - Street 1:2820 16TH ST NE
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-9600
Mailing Address - Country:US
Mailing Address - Phone:828-304-0840
Mailing Address - Fax:828-304-0943
Practice Address - Street 1:2820 16TH ST NE
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-9600
Practice Address - Country:US
Practice Address - Phone:828-304-0840
Practice Address - Fax:828-304-0943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-16
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty