Provider Demographics
NPI:1780725986
Name:HIGHLANDS SURGICAL ASSOC
Entity type:Organization
Organization Name:HIGHLANDS SURGICAL ASSOC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SYED
Authorized Official - Middle Name:G
Authorized Official - Last Name:BADRUDDUJA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-886-8183
Mailing Address - Street 1:400 UNIVERSITY DR STE 203
Mailing Address - Street 2:
Mailing Address - City:PRESTONSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41653-1080
Mailing Address - Country:US
Mailing Address - Phone:606-886-8183
Mailing Address - Fax:606-886-0575
Practice Address - Street 1:400 UNIVERSITY DR STE 203
Practice Address - Street 2:
Practice Address - City:PRESTONSBURG
Practice Address - State:KY
Practice Address - Zip Code:41653-1080
Practice Address - Country:US
Practice Address - Phone:606-886-8183
Practice Address - Fax:606-886-0575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY17825208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000057545OtherBCBS
KY65901951Medicaid
KY65901951Medicaid
W79470Medicare UPIN