South Park Medical Clinic PA

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

21863 Issued in NC

Legal business name

SOUTH PARK MEDICAL CLINIC PA

Practice address

133 1St Ave SE
Hickory, NC 28602-3005

Phone

(828) 322-5915

Fax

(828) 345-0387

NPI assigned

Jul 27, 2005

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Elbert Andrew Rudisill Jr., MD

Title

President

Phone

(828) 322-5915

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1122422400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1083614564",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "133 1ST AVE SE",
            "city": "HICKORY",
            "state": "NC",
            "postal_code": "286023005",
            "telephone_number": "828-322-5915",
            "fax_number": "828-345-0387"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "133 1ST AVE SE",
            "city": "HICKORY",
            "state": "NC",
            "postal_code": "286023005",
            "telephone_number": "828-322-5915",
            "fax_number": "828-345-0387"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH PARK MEDICAL CLINIC PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "RUDISILL",
        "authorized_official_first_name": "ELBERT",
        "authorized_official_middle_name": "ANDREW",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "828-322-5915",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "21863",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8902716",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Garrett Carl Snyder, PT
• Karah Snyder, DO
• John A Soli III, PHARMD, MBA
• Solutions of Hickory, PA
• Victor Sorrell, R.PH.
• Brooke Ann Southard, PT, DPT
• Southeast Medical & Mobility Supply Inc
• Southern Assisted Living, LLC. (Brookdale Hickory Northeast)
• Kelsey Paige Spangler, PT, DPT
• Ellen E Sparks, OTD, OTR/L

• Family Medicine Physician in Hickory, NC
• Providers in Hickory, NC by specialty
• Family Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.