Healthcare Provider Details

I. General information

NPI: 1205883626
Provider Name (Legal Business Name): HIGHLAND MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 09/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 PALMETTO ST
NEW SMYRNA BEACH FL
32168-7327
US

IV. Provider business mailing address

612 PALMETTO ST
NEW SMYRNA BEACH FL
32168-7327
US

V. Phone/Fax

Practice location:
  • Phone: 386-423-5500
  • Fax:
Mailing address:
  • Phone: 386-423-5500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number800020286
License Number StateFL

VIII. Authorized Official

Name: DR. MARK A NAGRANI
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 386-423-5500