=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891871000
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HIGHLANDS REGIONAL MEDICAL CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/31/2006
-----------------------------------------------------
Last Update Date | 06/26/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5000 KY ROUTE 321
-----------------------------------------------------
City | PRESTONSBURG
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 41653-9113
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-886-8511
-----------------------------------------------------
Fax | 606-886-7761
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 668
-----------------------------------------------------
City | PRESTONSBURG
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 41653-0668
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-886-8511
-----------------------------------------------------
Fax | 606-886-7761
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | MR. JACK G BLACKWELL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 606-886-7548
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 273R00000X
-----------------------------------------------------
Taxonomy Name | Psychiatric Hospital Unit
-----------------------------------------------------
License Number | 100124
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------