Basic Information
| Provider Information | |||||||||
| NPI: | 1720211618 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HIGHLANDS MEDICAL PARTNERS II | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5230 KY ROUTE 321 | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | PRESTONSBURG | ||||||||
| State: | KY | ||||||||
| PostalCode: | 416539168 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6068867747 | ||||||||
| FaxNumber: | 6068861316 | ||||||||
| Practice Location | |||||||||
| Address1: | 5230 KY ROUTE 321 | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | PRESTONSBURG | ||||||||
| State: | KY | ||||||||
| PostalCode: | 416539168 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6068867747 | ||||||||
| FaxNumber: | 6068861316 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/26/2009 | ||||||||
| LastUpdateDate: | 08/26/2009 | ||||||||
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| AuthorizedOfficialLastName: | BLACKWELL | ||||||||
| AuthorizedOfficialFirstName: | JACK | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGING PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 6068867548 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QS1200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Sleep Disorder Diagnostic |
No ID Information.