Provider Demographics
NPI:1235213596
Name:ANAHEIM HILLS PODIATRY GROUP
Entity Type:Organization
Organization Name:ANAHEIM HILLS PODIATRY GROUP
Other - Org Name:ANAHEIM HILLS PODIATRY GROUP
Other - Org Type:Other Name
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:PREECE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-974-3338
Mailing Address - Street 1:6200 E CANYON RIM RD
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-4317
Mailing Address - Country:US
Mailing Address - Phone:714-974-3338
Mailing Address - Fax:714-974-7683
Practice Address - Street 1:6200 E CANYON RIM RD STE 111E
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92807-4313
Practice Address - Country:US
Practice Address - Phone:714-974-3338
Practice Address - Fax:714-974-7683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ64700ZOtherBLUESHIELD GRP # - AHPG
CAZZZ65384ZOtherBLUE SHIELD GRP # -CORONA
CAZZZ65384ZOtherBLUE SHIELD GRP # -CORONA
CAZZZ31923ZMedicare ID - Type UnspecifiedNO. CALIFORNIA GROUP #
CAW16846Medicare ID - Type UnspecifiedSO. CALIFORNIA GROUP #
CAZZZ64700ZOtherBLUESHIELD GRP # - AHPG