Provider Demographics
NPI:1982929170
Name:HIGHLANDS PODIATRY, P.L.C.
Entity Type:Organization
Organization Name:HIGHLANDS PODIATRY, P.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MANAGER/PODIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:423-764-2299
Mailing Address - Street 1:2765 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-1828
Mailing Address - Country:US
Mailing Address - Phone:423-764-2299
Mailing Address - Fax:423-968-3340
Practice Address - Street 1:391 FALLS DR NW
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210-8093
Practice Address - Country:US
Practice Address - Phone:423-764-2299
Practice Address - Fax:423-968-3340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-31
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103301011213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA385776OtherBLUE CROSS VA FOR TN PATIENTS
VA404529OtherBLUE CROSS FOR VA
VA480034380OtherRAILROAD MEDICARE
VAVAA101623Medicare PIN
VA385776OtherBLUE CROSS VA FOR TN PATIENTS