Provider Demographics
NPI:1184803264
Name:FOOTHILLS MEDICAL ASSOCIATES
Entity type:Organization
Organization Name:FOOTHILLS MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:K
Authorized Official - Last Name:VIAR
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:828-894-5627
Mailing Address - Street 1:PO BOX 8
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NC
Mailing Address - Zip Code:28722-0008
Mailing Address - Country:US
Mailing Address - Phone:828-894-5627
Mailing Address - Fax:828-894-5879
Practice Address - Street 1:801 W MILLS ST
Practice Address - Street 2:SUITE C
Practice Address - City:COLUMBUS
Practice Address - State:NC
Practice Address - Zip Code:28722-8494
Practice Address - Country:US
Practice Address - Phone:828-894-5627
Practice Address - Fax:828-894-5879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-25
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9901067261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2401204Medicare PIN