Provider Demographics
NPI:1689964322
Name:HIGHLAND SPRINGS MEDICAL PC
Entity Type:Organization
Organization Name:HIGHLAND SPRINGS MEDICAL PC
Other - Org Name:PAIN MANAGEMENT OF WASHINGTON CTY
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICAHRD
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLEYN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-330-6320
Mailing Address - Street 1:3114 BROWNS MILL RD
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-1417
Mailing Address - Country:US
Mailing Address - Phone:865-330-6320
Mailing Address - Fax:
Practice Address - Street 1:3114 BROWNS MILL RD
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-1417
Practice Address - Country:US
Practice Address - Phone:865-330-6320
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-14
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC1804111N00000X
TNMD018742207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty