1487702130 NPI number — HICKORY RADIATION ONCOLOGY, PA

Table of content: (NPI 1487702130)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487702130 NPI number — HICKORY RADIATION ONCOLOGY, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HICKORY RADIATION ONCOLOGY, PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SIGMON RADIATION ONCOLOGY, PA
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487702130
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/02/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2654
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HICKORY
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28603
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-326-3856
Provider Business Mailing Address Fax Number:
828-322-7747

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
810 FAIRGROVE CHURCH ROAD, SE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HICKORY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-326-3856
Provider Business Practice Location Address Fax Number:
828-322-7747
Provider Enumeration Date:
01/08/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SIGMON
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
828-326-3856

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0266B , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".