Provider Demographics
NPI:1003329921
Name:HIGHLAND FAMILY CLINIC
Entity Type:Organization
Organization Name:HIGHLAND FAMILY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:HIGHLAND
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:931-723-2265
Mailing Address - Street 1:1321 MCARTHUR ST STE B
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37355-2493
Mailing Address - Country:US
Mailing Address - Phone:931-723-2265
Mailing Address - Fax:
Practice Address - Street 1:1321 MCARTHUR ST STE B
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37355-2493
Practice Address - Country:US
Practice Address - Phone:931-723-2265
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-14
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN6245207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3902511Medicaid
TN4045798OtherBLUE CROSS
TN10076993OtherAMERIGROUP