1205893351 NPI number — HIGHLAND DISTRICT HOSPITAL PROFESSIONAL SERVICES CORPORATION

Table of content: (NPI 1205893351)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205893351 NPI number — HIGHLAND DISTRICT HOSPITAL PROFESSIONAL SERVICES CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HIGHLAND DISTRICT HOSPITAL PROFESSIONAL SERVICES CORPORATION
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:
Provider Other Organization Name Type Code:
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:
1205893351
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/05/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 637735
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45263-7735
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-393-6101
Provider Business Mailing Address Fax Number:
937-393-6278

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1275 N HIGH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HILLSBORO
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45133-8273
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-393-6101
Provider Business Practice Location Address Fax Number:
937-393-6278
Provider Enumeration Date:
05/01/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
COOMER
Authorized Official First Name:
TRACY
Authorized Official Middle Name:
Authorized Official Title or Position:
VP, PROFESSIONAL SERVICES
Authorized Official Telephone Number:
937-393-6101

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207QS0010X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 2504409 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".