=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215302708
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HIGHLAND MEDICAL CENTER INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/09/2015
-----------------------------------------------------
Last Update Date | 02/23/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 120 JACKSON RIVER RD
-----------------------------------------------------
City | MONTEREY
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24465-2416
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-468-6421
-----------------------------------------------------
Fax | 540-468-3318
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 490
-----------------------------------------------------
City | MONTEREY
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24465-0490
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-468-6421
-----------------------------------------------------
Fax | 540-468-3318
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DEBRA PERDUE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 540-468-6421
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 0201004680
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------