Provider Demographics
NPI:1144300286
Name:HIGH COUNTRY NEUROLOGY, PC
Entity type:Organization
Organization Name:HIGH COUNTRY NEUROLOGY, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:MILLER
Authorized Official - Last Name:CRITTENDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-262-0600
Mailing Address - Street 1:400 SHADOWLINE DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-5089
Mailing Address - Country:US
Mailing Address - Phone:828-262-0600
Mailing Address - Fax:828-262-0807
Practice Address - Street 1:400 SHADOWLINE DR
Practice Address - Street 2:SUITE 202
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-5089
Practice Address - Country:US
Practice Address - Phone:828-262-0600
Practice Address - Fax:828-262-0807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9601279 &94014532084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC791120XMedicaid
NC89015NTMedicaid
1073793311OtherNPI BURTON LEE KENNEDY
NC1740259225OtherNPI JEFFREY CRITTENDEN
NC89015NTMedicaid
NC1740259225OtherNPI JEFFREY CRITTENDEN
NCE19885Medicare UPIN
NC2233927BMedicare ID - Type UnspecifiedJEFFREY P CRITTENDENMD