1750336756 NPI number — CITY OF HIGHLAND

Table of content: (NPI 1750336756)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750336756 NPI number — CITY OF HIGHLAND

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF HIGHLAND
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HIGHLAND AMBULANCE SERVICE
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750336756
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/27/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2610 PLAZA DR
Provider Second Line Business Mailing Address:
PO BOX 218
Provider Business Mailing Address City Name:
HIGHLAND
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62249-1123
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
618-651-9801
Provider Business Mailing Address Fax Number:
618-654-1901

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1122 BROADWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HIGHLAND
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62249-1917
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-654-5901
Provider Business Practice Location Address Fax Number:
618-654-6829
Provider Enumeration Date:
05/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NICKLIN
Authorized Official First Name:
STEPHANIE
Authorized Official Middle Name:
L
Authorized Official Title or Position:
BILLING
Authorized Official Telephone Number:
618-651-9801

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  1690161 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0006019802 . This is a "BCBS OF IL" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 590155556 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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