Basic Information
Provider Information
NPI: 1336412261
EntityType: 2
ReplacementNPI:  
OrganizationName: HIGHLAND DISTRICT HOSPITAL
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: GREENFIELD MEDICAL SERVICES
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1275 N HIGH ST
Address2:  
City: HILLSBORO
State: OH
PostalCode: 451338273
CountryCode: US
TelephoneNumber: 9373936100
FaxNumber: 9373936278
Practice Location
Address1: 1092 JEFFERSON ST
Address2:  
City: GREENFIELD
State: OH
PostalCode: 45123
CountryCode: US
TelephoneNumber: 9379811121
FaxNumber: 9379815660
Other Information
ProviderEnumerationDate: 02/23/2012
LastUpdateDate: 08/13/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: LENNARTZ
AuthorizedOfficialFirstName: RANDAL
AuthorizedOfficialMiddleName: P
AuthorizedOfficialTitleorPosition: CEO
AuthorizedOfficialTelephone: 9378406575
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
261QR1300X  Y Ambulatory Health Care FacilitiesClinic/CenterRural Health

No ID Information.


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