Healthcare Provider Details

I. General information

NPI: 1285917104
Provider Name (Legal Business Name): HIGHLAND NEUROLOGY & INJURY ASSOCIATES, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2011
Last Update Date: 09/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4123 TAYLOR BLVD
LOUISVILLE KY
40215-2341
US

IV. Provider business mailing address

2241 HIGHVIEW CHURCH RD
BLOOMFIELD KY
40008-7520
US

V. Phone/Fax

Practice location:
  • Phone: 502-363-7172
  • Fax: 502-363-7174
Mailing address:
  • Phone: 502-354-0292
  • Fax: 502-354-0332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number25368
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number25368
License Number StateKY

VIII. Authorized Official

Name: BECKY CHESSER
Title or Position: OFFICE MANAGER
Credential:
Phone: 502-354-0292