Provider Demographics
NPI:1396702445
Name:HIGHLAND HEALTH PROVIDERS CORP
Entity type:Organization
Organization Name:HIGHLAND HEALTH PROVIDERS CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:WARIX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-393-5753
Mailing Address - Street 1:1487 NORTH HIGH ST. SUITE 102, ATTN: CFO
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45133-7736
Mailing Address - Country:US
Mailing Address - Phone:937-840-6617
Mailing Address - Fax:937-393-6278
Practice Address - Street 1:1487 N HIGH ST
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OH
Practice Address - Zip Code:45133-8496
Practice Address - Country:US
Practice Address - Phone:937-393-3406
Practice Address - Fax:937-393-0511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-01
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QF0400X
OHAPRN.CNP.08211207Q00000X
OH35.067788207V00000X
OH34010808207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)Group - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2284193Medicaid
OH9319991Medicare PIN