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Organization
SOUTH PARK MEDICAL CLINIC PA
Active
Organization
SOUTH PARK MEDICAL CLINIC PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ELBERT ANDREW RUDISILL JR. MD (PRESIDENT)
(828) 322-5915
Entity
Organization
Contact information
Practice address
133 1ST AVE SE, HICKORY, NC 28602-3005
(828) 322-5915
(828) 345-0387
Mailing address
133 1ST AVE SE, HICKORY, NC 28602-3005
(828) 322-5915
(828) 345-0387
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
21863
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8902716
—
NC
Enumeration date
07/27/2005
Last updated
08/22/2020
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