MEDICARE: HIGHLAND DISTRICT HOSPITAL PROFESSIONAL SERVICES CORPORATION

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	261QR1300X	Rural Health Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497712533
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HIGHLAND DISTRICT HOSPITAL PROFESSIONAL SERVICES CORPORATION

Provider Business Mailing Address
First Line	:	1275 N HIGH ST
Second Line	:
City	:	HILLSBORO
State	:	OH
Zip	:	45133-8273
Country	:	US
Telephone Number	:	937-393-6100
Fax Number	:	937-393-1658

Provider Business Practice Location Address
First Line	:	1092 JEFFERSON ST
Second Line	:
City	:	GREENFIELD
State	:	OH
Zip	:	45123-8319
Country	:	US
Telephone Number	:	937-981-1121
Fax Number	:	937-981-5660

Authorized Official
Title or Position	:	VP OF PROFESSIONAL SERVICES
Name	:	TRACY COOMER
Credential	:
Telephone Number	:	937-393-6100

Provider Enumeration Date	:	05/01/2006
Last Update Date	:	02/09/2017

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