Provider Demographics
NPI:1427019603
Name:HICKORY HEART, LUNG & VASCULAR ASSOCIATES, PA
Entity type:Organization
Organization Name:HICKORY HEART, LUNG & VASCULAR ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CEMIL
Authorized Official - Middle Name:M
Authorized Official - Last Name:PURUT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-323-1100
Mailing Address - Street 1:420 N CENTER ST
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-5046
Mailing Address - Country:US
Mailing Address - Phone:828-323-1100
Mailing Address - Fax:828-324-9189
Practice Address - Street 1:420 N CENTER ST
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-5046
Practice Address - Country:US
Practice Address - Phone:828-323-1100
Practice Address - Fax:828-324-9189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-29
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC61915208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890181NMedicaid
2312613AMedicare ID - Type Unspecified