Healthcare Provider Details

I. General information

NPI: 1306803440
Provider Name (Legal Business Name): HIGHLAND DISTRICT HOSPITAL PROFESSIONAL SERVICES CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 08/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1402 N HIGH ST
HILLSBORO OH
45133-8514
US

IV. Provider business mailing address

PO BOX 70 1404 NORTH HIGH STREET
HILLSBORO OH
45133
US

V. Phone/Fax

Practice location:
  • Phone: 937-393-4899
  • Fax: 937-393-4996
Mailing address:
  • Phone: 937-393-1129
  • Fax: 937-393-1658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TRACY COOMER
Title or Position: VP OF PROFESSIONAL SERVICES
Credential:
Phone: 937-393-6100