1184078479 NPI number — HIGHLANDS FOOT & ANKLE

Table of content: (NPI 1184078479)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184078479 NPI number — HIGHLANDS FOOT & ANKLE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HIGHLANDS FOOT & ANKLE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184078479
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/03/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2524 WASHINGTON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WACO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76710-7447
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-484-4061
Provider Business Mailing Address Fax Number:
254-313-1236

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2524 WASHINGTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WACO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76710-7447
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
254-300-7703
Provider Business Practice Location Address Fax Number:
254-300-7709
Provider Enumeration Date:
04/22/2016

Additional Information

Authorized Official

Authorized Official Last Name:
SAPPINGTON
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
C
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
254-300-7703

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  2222 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QP1100X , with the licence number: 2222 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X , with the licence number: 2222 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: APPROVEDPENDING . This is a "DMERC" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 3647661-04 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: PENDING . This is a "SUPERIOR HEALTH" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 00E4Z4 . This is a "BCBS TX" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8FX246 . This is a "BCBS TX" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1184078479 . This is a "CIGNA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1447296843 . This is a "SCOTT & WHITE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 3647661-03 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: PENDING . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1184078479 . This is a "SCOTT & WHITE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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