Higginbotham, Jack W.

Higginbotham, Jack W. is an individual health care provider with primary practice located at 500 Martha Jefferson Dr Charlottesville Radiology, Charlottesville VA 22911-4668. He recently has only one registered license in Allopathic & Osteopathic Physicians / Diagnostic Radiology, which is considered as his primary health care specialty. Higginbotham, Jack W. can be contacted via phone (434) 244-4580.

Contact Information

Primary practice address
500 Martha Jefferson Dr Charlottesville Radiology Charlottesville VA 22911-4668
Phone: (434) 244-4580
Fax: (434) 244-4579
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Diagnostic Radiology 2085R0202X 0101232780 Virginia

Profile Details

NPI number 1700859253
LBN Legal business name Higginbotham, Jack W.
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 7th, 2006
Last updated Apr 1st, 2021 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1700859253 NPPES
Virginia MEDICAID 010140242
Virginia Other P00224457

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