Provider Demographics
NPI:1699211342
Name:ENHANCE ORTHOPEDIC SURGERY, LLC
Entity Type:Organization
Organization Name:ENHANCE ORTHOPEDIC SURGERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:HIGHTOWER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:612-710-6092
Mailing Address - Street 1:1200 AIRPORT HEIGHTS DR
Mailing Address - Street 2:SUITE 190
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-2965
Mailing Address - Country:US
Mailing Address - Phone:907-444-5501
Mailing Address - Fax:907-222-5947
Practice Address - Street 1:1200 AIRPORT HEIGHTS DR
Practice Address - Street 2:SUITE 190
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-2965
Practice Address - Country:US
Practice Address - Phone:907-444-5501
Practice Address - Fax:907-222-5947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-18
Last Update Date:2019-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK7493207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1579733Medicaid