1093713364 NPI number — HIGHLAND WOMEN'S CARE

Table of content: (NPI 1093713364)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093713364 NPI number — HIGHLAND WOMEN'S CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HIGHLAND WOMEN'S CARE
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:
1093713364
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3103 W KUNKLE BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FREEPORT
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61032-6922
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-233-0999
Provider Business Mailing Address Fax Number:
815-233-7255

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3103 W KUNKLE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FREEPORT
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61032-6922
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-233-0999
Provider Business Practice Location Address Fax Number:
815-233-7255
Provider Enumeration Date:
07/12/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HILL
Authorized Official First Name:
DAWN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
BUSINESS MANAGER
Authorized Official Telephone Number:
815-232-0999

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 363LW0102X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 08932003 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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