Southport Internal Medicine PA

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

33376 Issued in NC

Legal business name

SOUTHPORT INTERNAL MEDICINE PA

Practice address

1513 N Howe St
Unit 6
Southport, NC 28461-2769

Phone

(910) 457-9127

Fax

(910) 269-2884

NPI assigned

Feb 25, 2011

Last updated

Jul 6, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Douglas K Hiltz Jr., MDNPI 1306862594

Title

President

Phone

(910) 457-9127

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Douglas K Hiltz, MD

  • Internal Medicine Physician
  • Southport, NC
  • NPI 1306862594
  Authorized official Same address or phone

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

{
    "created_epoch": "1298592000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1309910400000",
    "number": "1528365657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10922",
            "city": "SOUTHPORT",
            "state": "NC",
            "postal_code": "284610922",
            "telephone_number": "910-457-9127",
            "fax_number": "910-269-2884"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1513 N HOWE ST",
            "address_2": "UNIT 6",
            "city": "SOUTHPORT",
            "state": "NC",
            "postal_code": "284612769",
            "telephone_number": "910-457-9127",
            "fax_number": "910-269-2884"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHPORT INTERNAL MEDICINE PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-02-25",
        "last_updated": "2011-07-06",
        "status": "A",
        "authorized_official_last_name": "HILTZ",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "910-457-9127",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": "33376",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPT OF THE SECRETARY OF STATE CERTIFICATION NUMBER",
            "identifier": "C201101100100-1",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA WAIVED CERTIFICATE",
            "identifier": "34D0246020",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Molly Ann Smyser, D.C.
• South East Access Inc
• Southern Cross
• Southport Counseling Services, PLLC
• Southport Eye Care OD PLLC
• Southport Pulmonary Medicine, PLLC
• Southport Surgical Associates, P.a.
• Southport Urgent Care
• Southport Urgent Care PLLS
• Christine Louise Sparks, O.T.

• Internal Medicine Physician in Southport, NC
• Providers in Southport, NC by specialty
• Internal Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2011; 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.