Basic Information
| Provider Information | |||||||||
| NPI: | 1639470388 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HIGHLAND DISTRICT HOSPITAL PROFESSIONAL SERVICES CORPORATION | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | LYNCHBURG MEDICAL CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 70 | ||||||||
| Address2: | |||||||||
| City: | HILLSBORO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 451330070 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9373931129 | ||||||||
| FaxNumber: | 9373931658 | ||||||||
| Practice Location | |||||||||
| Address1: | 8900 STATE ROUTE 134 | ||||||||
| Address2: | |||||||||
| City: | LYNCHBURG | ||||||||
| State: | OH | ||||||||
| PostalCode: | 451429272 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9373642346 | ||||||||
| FaxNumber: | 9373646960 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/11/2010 | ||||||||
| LastUpdateDate: | 11/11/2010 | ||||||||
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| AuthorizedOfficialLastName: | BAER | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 9373936101 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | HIGHLAND DISTRICT HOSPITAL FOUNDATION CORPORATION | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.