Provider Demographics
NPI:1780322552
Name:NICK HIGINBOTHAM DO PC
Entity type:Organization
Organization Name:NICK HIGINBOTHAM DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:D
Authorized Official - Last Name:HIGINBOTHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:304-487-2297
Mailing Address - Street 1:311 COURTHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740-2421
Mailing Address - Country:US
Mailing Address - Phone:304-487-2297
Mailing Address - Fax:
Practice Address - Street 1:311 COURTHOUSE RD
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-2421
Practice Address - Country:US
Practice Address - Phone:304-487-2297
Practice Address - Fax:304-487-4802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-23
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty