Provider Demographics
NPI:1811932718
Name:HIGHLANDS SURGICAL SPECIALISTS, PA
Entity type:Organization
Organization Name:HIGHLANDS SURGICAL SPECIALISTS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-349-6890
Mailing Address - Street 1:56 MEDICAL PARK DR
Mailing Address - Street 2:SUITE 204
Mailing Address - City:FRANKLIN
Mailing Address - State:NC
Mailing Address - Zip Code:28734-2632
Mailing Address - Country:US
Mailing Address - Phone:828-349-6890
Mailing Address - Fax:828-349-6891
Practice Address - Street 1:56 MEDICAL PARK DR
Practice Address - Street 2:SUITE 204
Practice Address - City:FRANKLIN
Practice Address - State:NC
Practice Address - Zip Code:28734-2632
Practice Address - Country:US
Practice Address - Phone:828-349-6890
Practice Address - Fax:828-349-6891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8971628Medicaid
NC71628OtherHEALTH CHOICE
NCDE8800OtherRAILROAD MEDICARE
GA000828165BMedicaid
NC71628OtherBLUE CROSS
NC182523OtherMEDCOST
GA197726OtherBLUE CROSS
NC180874OtherPREFERRED CARE
NC2348409OtherAETNA
NC7579719OtherAETNA
NC8971628OtherWELLCARE
NC8971628OtherWELLCARE
NC2348409OtherAETNA
GA197726OtherBLUE CROSS
NC71628OtherBLUE CROSS