MEDICARE: HIGHLANDS MEDICAL GROUP, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207VG0400X	Gynecology Physician
2	2085B0100X	Body Imaging Physician
3	2085U0001X	Diagnostic Ultrasound Physician
4	261QP2300X	Primary Care Clinic/Center
5	261QU0200X	Urgent Care Clinic/Center
6	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1801306477
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HIGHLANDS MEDICAL GROUP, LLC

Provider Business Mailing Address
First Line	:	7680 GODDARD ST STE 100
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-8233
Country	:	US
Telephone Number	:	719-502-9779
Fax Number	:

Provider Business Practice Location Address
First Line	:	7680 GODDARD ST STE 100
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-8233
Country	:	US
Telephone Number	:	719-502-9779
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	DENNIS L. FLINT
Credential	:
Telephone Number	:	719-502-9779

Provider Enumeration Date	:	10/09/2017
Last Update Date	:	10/09/2017

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