1811932718 NPI number — HIGHLANDS SURGICAL SPECIALISTS, PA

Table of content: (NPI 1811932718)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811932718 NPI number — HIGHLANDS SURGICAL SPECIALISTS, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HIGHLANDS SURGICAL SPECIALISTS, PA
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:
1811932718
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
56 MEDICAL PARK DR
Provider Second Line Business Mailing Address:
SUITE 204
Provider Business Mailing Address City Name:
FRANKLIN
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28734-2632
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-349-6890
Provider Business Mailing Address Fax Number:
828-349-6891

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
56 MEDICAL PARK DR
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
FRANKLIN
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28734-2632
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-349-6890
Provider Business Practice Location Address Fax Number:
828-349-6891
Provider Enumeration Date:
06/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RICHARDSON
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
DALE
Authorized Official Title or Position:
OWNER/PRESIDENT
Authorized Official Telephone Number:
828-349-6890

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 8971628 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 71628 . This is a "HEALTH CHOICE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: DE8800 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 000828165B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 71628 . This is a "BLUE CROSS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 182523 . This is a "MEDCOST" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 197726 . This is a "BLUE CROSS" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 180874 . This is a "PREFERRED CARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 2348409 . This is a "AETNA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 7579719 . This is a "AETNA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 8971628 . This is a "WELLCARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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