| Impsp | |
|
929 15th St Ne Suite 100 Hickory NC 28601-4161 | |
| (828) 325-0555 | |
| (828) 267-7555 |
| Full Name | Impsp |
|---|---|
| Speciality | Internal Medicine |
| Location | 929 15th St Ne, Hickory, North Carolina |
| Authorized Official Name and Position | Teresa P Killian (PRACTICE MANAGER) |
| Authorized Official Contact | 8283250555 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Impsp Po Box 1447 Hickory NC 28603-1447 Ph: (828) 325-0555 | Impsp 929 15th St Ne Suite 100 Hickory NC 28601-4161 Ph: (828) 325-0555 |
| NPI Number | 1417180662 |
|---|---|
| Provider Enumeration Date | 09/03/2009 |
| Last Update Date | 06/25/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417180662 | NPI | - | NPPES |
| 5913662 | Medicaid | NC | |
| 022MM | Other | NC | BCBS |
| 513278 | Other | NC | MANAGED HEALTH NETWORK |
| DQ4195 | Other | NC | RAILROAD MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 200501179 (North Carolina) | Primary |
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 200501179 (North Carolina) | Secondary |
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