1750665592 NPI number — HIGHLAND COMMUNITY CLINIC NETWORK

Table of content: (NPI 1750665592)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750665592 NPI number — HIGHLAND COMMUNITY CLINIC NETWORK

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HIGHLAND COMMUNITY CLINIC NETWORK
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:
1750665592
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/28/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1375 CORPORATE SQUARE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SLIDELL
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70458-3147
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
985-726-2655
Provider Business Mailing Address Fax Number:
985-643-9808

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
801 GOODYEAR BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PICAYUNE
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39466-3221
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-726-2655
Provider Business Practice Location Address Fax Number:
985-643-9808
Provider Enumeration Date:
09/28/2011

Additional Information

Authorized Official

Authorized Official Last Name:
STEVENS
Authorized Official First Name:
BRYAN
Authorized Official Middle Name:
N.
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
601-798-4711

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  19353 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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