1. Home
  2. Directory
  3. North Carolina
  4. Hickory
  5. Family Medicine
  6. NPI Profile

SOUTH PARK MEDICAL CLINIC PA
NPI 1083614564
Family Medicine in Hickory, NC

Active since July 27, 2005
133 1ST AVE SE, HICKORY, NC 28602(828) 322-5915(828) 345-0387 Get Directions Write a Review

NPPES record last updated: August 22, 2020. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About South Park Medical Clinic Pa NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SOUTH PARK MEDICAL CLINIC PA (NPI 1083614564) is a healthcare organization registered as a family medicine in Hickory, North Carolina and active in the NPI registry since July 2005. The organization lists Elbert Andrew Rudisill, President, as its authorized official.

NPPES Registry Identity

NPI1083614564
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameSOUTH PARK MEDICAL CLINIC PA
Location Address133 1ST AVE SEHickory, NC 28602-3005
Mailing Address133 1st Ave SeHickory, NC 28602-3005 · (828) 322-5915 · Fax (828) 345-0387
Phone(828) 322-5915
Fax(828) 345-0387
Organization SubpartNo
Authorized OfficialElbert Andrew RudisillPresident · (828) 322-5915
Enumeration DateJuly 27, 2005
Last NPPES UpdateAugust 22, 2020
✔ NPI 1083614564 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
License✔ Licensed in NC · 21863
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
133 1ST AVE SE, Hickory, NC 28602
Open in Google Maps ↗

Other Identifiers 1

Medicaid8902716NC

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES 10

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DEBRA KAY COOK LCSWA
Social Worker (Clinical)
133 1ST AVE SE
HICKORY, NC 28602
Catawba County (828) 944-4544
BRANDIE TERIFAJ
Social Worker (Clinical)
133 1ST AVE SE
HICKORY, NC 28602
Catawba County (828) 994-4544
VALARIE CRISP SUMMEROW MSN, ANPBC
Nurse Practitioner
133 1ST AVE SE
HICKORY, NC 28602
Catawba County (828) 994-4544
GASTON FAMILY HEALTH SERVICES, INC
Clinic/Center (Federally Qualified Health Center (FQHC))
133 1ST AVE SE
HICKORY, NC 28602
Catawba County (828) 994-4544
DR. LEAH RUTH BROADHURST MD
Internal Medicine
133 1ST AVE SE
HICKORY, NC 28602
Catawba County (828) 994-4544
BRANDY NICOLE MCMILLAN PMHNP-BC
Nurse Practitioner (Psychiatric/Mental Health)
133 1ST AVE SE
HICKORY, NC 28602
Catawba County (828) 994-4544
SHARON PARKER LCAS ,LCMHC
Counselor (Mental Health)
133 1ST AVE SE
HICKORY, NC 28602
Catawba County (828) 994-4544
SYLVIA VANG
Social Worker
133 1ST AVE SE
HICKORY, NC 28602
Catawba County (828) 994-4544

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is South Park Medical Clinic PA's NPI number?

The NPI number for South Park Medical Clinic PA is 1083614564. It was assigned to this organization in the NPPES registry on July 27, 2005.

Where is South Park Medical Clinic PA located?

South Park Medical Clinic PA is located at 133 1st Ave SE, Hickory, NC 28602. The listed phone number is (828) 322-5915.

What is South Park Medical Clinic PA's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

When was this NPI record last updated?

The NPPES record for South Park Medical Clinic PA was last updated on August 22, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.