Provider Demographics
NPI:1407997786
Name:NORTH HILLS PODIATRY
Entity Type:Organization
Organization Name:NORTH HILLS PODIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CLINTON
Authorized Official - Middle Name:R
Authorized Official - Last Name:LOWERY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:724-935-5533
Mailing Address - Street 1:10900 PERRY HWY
Mailing Address - Street 2:
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-8370
Mailing Address - Country:US
Mailing Address - Phone:724-935-5533
Mailing Address - Fax:724-935-5890
Practice Address - Street 1:10900 PERRY HWY
Practice Address - Street 2:
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-8370
Practice Address - Country:US
Practice Address - Phone:724-935-5533
Practice Address - Fax:724-935-5890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002876-L213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA169867OtherHIGHMARK BLUE SHIELD PROV
PA01064719Medicaid
PA169867OtherHIGHMARK BLUE SHIELD PROV