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General NPI Number Information
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NPI Number | 1750336756
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Entity Type | Organization
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Legal Business Name | CITY OF HIGHLAND
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Dates
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Enumeration Date | 05/24/2006
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Last Update Date | 03/27/2009
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Provider Practice Location Address
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Address Line | 1122 BROADWAY
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City | HIGHLAND
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State | IL
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Zip | 62249-1917
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Country | US
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Telephone | 618-654-5901
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Fax | 618-654-6829
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Provider Business Mailing Address
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Address Line | 2610 PLAZA DR PO BOX 218
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City | HIGHLAND
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State | IL
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Zip | 62249-1123
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Country | US
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Telephone | 618-651-9801
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Fax | 618-654-1901
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Authorized Official
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Title or Position | BILLING
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Name | MRS. STEPHANIE L NICKLIN
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Credential |
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Telephone | 618-651-9801
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | 1690161
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License Number State | IL
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