Healthcare Provider Details

I. General information

NPI: 1194784280
Provider Name (Legal Business Name): HIGHLAND MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 02/23/2022
Certification Date: 02/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 JACKSON RIVER ROAD
MONTEREY VA
24465
US

IV. Provider business mailing address

PO BOX 490
MONTEREY VA
24465-0490
US

V. Phone/Fax

Practice location:
  • Phone: 540-468-6400
  • Fax: 540-468-3301
Mailing address:
  • Phone: 540-468-6400
  • Fax: 540-468-3301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: JANICE ROBERSON ELLIS
Title or Position: CFO/HR
Credential: CPA
Phone: 540-468-6402