Provider Demographics
NPI:1063500809
Name:HIGH PLAINES FOOT SPECIALIST PA
Entity Type:Organization
Organization Name:HIGH PLAINES FOOT SPECIALIST PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAYNE
Authorized Official - Middle Name:A
Authorized Official - Last Name:DAMERON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:620-227-6661
Mailing Address - Street 1:2200 SUMMERLON CIRCLE
Mailing Address - Street 2:SUITE B
Mailing Address - City:DODGE CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67801
Mailing Address - Country:US
Mailing Address - Phone:620-227-6661
Mailing Address - Fax:620-227-7655
Practice Address - Street 1:2200 SUMMERLON CIRCLE
Practice Address - Street 2:SUITE B
Practice Address - City:DODGE CITY
Practice Address - State:KS
Practice Address - Zip Code:67801
Practice Address - Country:US
Practice Address - Phone:620-227-6661
Practice Address - Fax:620-227-7655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSDD5872OtherRAILROAD MEDICARE PROV. #
KSDD5872OtherRAILROAD MEDICARE PROV. #
KS114203Medicare PIN