MEDICARE: ANNA R HIGGINS ATC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer	AT0001188	CO

General Provider Information

NPI Number	:	1598191470
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNA R HIGGINS ATC

Provider Business Mailing Address
First Line	:	14 E CACHE LA POUDRE ST
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80903-3243
Country	:	US
Telephone Number	:	719-389-6208
Fax Number	:

Provider Business Practice Location Address
First Line	:	14 E CACHE LA POUDRE ST
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80903-3243
Country	:	US
Telephone Number	:	719-389-6208
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/23/2013
Last Update Date	:	09/23/2013

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