Healthcare Provider Details

I. General information

NPI: 1194818138
Provider Name (Legal Business Name): HIGHLANDS HOSPITAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 06/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 KY ROUTE 321
PRESTONSBURG KY
41653-9113
US

IV. Provider business mailing address

PO BOX 668
PRESTONSBURG KY
41653-0668
US

V. Phone/Fax

Practice location:
  • Phone: 606-886-8511
  • Fax: 606-886-7761
Mailing address:
  • Phone: 606-886-8511
  • Fax: 606-886-7761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number100124
License Number StateKY
# 5
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number100124
License Number StateKY
# 8
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 9
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number100124
License Number StateKY

VIII. Authorized Official

Name: MR. JACK G BLACKWELL
Title or Position: CFO
Credential:
Phone: 606-886-7548