Provider Demographics
NPI:1093561748
Name:HIGHLANDS VASECTOMY CLINIC
Entity type:Organization
Organization Name:HIGHLANDS VASECTOMY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:N
Authorized Official - Last Name:MCCRACKEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:423-797-1648
Mailing Address - Street 1:981 VOLUNTEER PKWY STE B
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-4284
Mailing Address - Country:US
Mailing Address - Phone:423-573-8100
Mailing Address - Fax:423-844-6626
Practice Address - Street 1:981 VOLUNTEER PKWY STE B
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-4284
Practice Address - Country:US
Practice Address - Phone:423-573-8100
Practice Address - Fax:423-844-6626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-24
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty