| Organization Name: | HIDA CLINIC, LLC |
| NPI Number: | 1154506699 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | EMILY JANE TATUM (SOLE ORGANIZER) |
| Mailing Address: | 1939 Shoal Creek Rd Murphy |
| State: | NC US |
| Postal Code: | 289068480 |
| Phone Number: | 8286445573 |
| Fax Number: | 8286445562 |
| NPI Enumeration Date: | 01/03/2008 |
| NPI Last Update Date: | 09/22/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | 2007-00088 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NC |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |