MEDICARE: HIGHLAND HOSPITAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center	000449-1	NY

General Provider Information

NPI Number	:	1629286265
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HIGHLAND HOSPITAL

Provider Business Mailing Address
First Line	:	1381 SOUTH AVE
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14620-2830
Country	:	US
Telephone Number	:	585-506-9484
Fax Number	:

Provider Business Practice Location Address
First Line	:	1381 SOUTH AVE
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14620-2830
Country	:	US
Telephone Number	:	585-506-9484
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL ASSOCIATE
Name	:	MRS. SALLY ROUSSEAU
Credential	:	M.S.W.
Telephone Number	:	585-506-9484

Provider Enumeration Date	:	05/18/2007
Last Update Date	:	08/22/2020

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Directions to “HIGHLAND HOSPITAL ” Practice Location

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