Basic Information
| Provider Information | |||||||||
| NPI: | 1184803264 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | FOOTHILLS MEDICAL ASSOCIATES | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 8 | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287220008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8288945627 | ||||||||
| FaxNumber: | 8288945879 | ||||||||
| Practice Location | |||||||||
| Address1: | 801 W MILLS ST | ||||||||
| Address2: | SUITE C | ||||||||
| City: | COLUMBUS | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287228494 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8288945627 | ||||||||
| FaxNumber: | 8288945879 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/25/2007 | ||||||||
| LastUpdateDate: | 10/25/2007 | ||||||||
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| AuthorizedOfficialLastName: | VIAR | ||||||||
| AuthorizedOfficialFirstName: | JEFFREY | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8288945627 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2300X | 9901067 | NC | Y | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
No ID Information.