| Desantis Family Practice | |
|
10 3rd Ave Ne Hickory NC 28601-5044 | |
| (828) 304-6363 | |
| (828) 304-0033 |
| Full Name | Desantis Family Practice |
|---|---|
| Speciality | Family Medicine |
| Location | 10 3rd Ave Ne, Hickory, North Carolina |
| Authorized Official Name and Position | Michael Christopher Desantis (PHYSICIAN) |
| Authorized Official Contact | 8283046363 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Desantis Family Practice 10 3rd Ave Ne Hickory NC 28601-5044 Ph: (828) 304-6363 | Desantis Family Practice 10 3rd Ave Ne Hickory NC 28601-5044 Ph: (828) 304-6363 |
| NPI Number | 1568763795 |
|---|---|
| Provider Enumeration Date | 11/04/2010 |
| Last Update Date | 04/04/2011 |
| Medicare PECOS PAC ID | 8921283854 |
|---|---|
| Medicare Enrollment ID | O20110419000685 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568763795 | NPI | - | NPPES |
| 7578132 | Other | NC | CIGNA HEALTHCARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (North Carolina) | Primary |
| Provider Name | Michael C Desantis |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1780610394 PECOS PAC ID: 6800794264 Enrollment ID: I20031222000804 |
| Provider Name | Karen Elizabeth Gimblet |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396997607 PECOS PAC ID: 9830320183 Enrollment ID: I20160222002230 |
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