Provider Demographics
NPI:1396336129
Name:FOOT CLINIC OF THE HIGH PLAINS PLLC
Entity type:Organization
Organization Name:FOOT CLINIC OF THE HIGH PLAINS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:Q
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:806-656-5006
Mailing Address - Street 1:2100 FM 2590 STE 200
Mailing Address - Street 2:
Mailing Address - City:CANYON
Mailing Address - State:TX
Mailing Address - Zip Code:79015-1982
Mailing Address - Country:US
Mailing Address - Phone:806-656-5006
Mailing Address - Fax:806-656-5008
Practice Address - Street 1:2100 FM 2590 STE 200
Practice Address - Street 2:
Practice Address - City:CANYON
Practice Address - State:TX
Practice Address - Zip Code:79015-1982
Practice Address - Country:US
Practice Address - Phone:806-656-5006
Practice Address - Fax:806-656-5008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-03
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty