Provider Demographics
NPI:1427376862
Name:HIGHLAND MEDICAL CENTER INC
Entity Type:Organization
Organization Name:HIGHLAND MEDICAL CENTER INC
Other - Org Name:HIGHLAND MEDICAL CENTER SCHOOL BASE HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO/HR
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:ROBERSON
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-468-6402
Mailing Address - Street 1:PO BOX 490
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:VA
Mailing Address - Zip Code:24465-0490
Mailing Address - Country:US
Mailing Address - Phone:540-468-3300
Mailing Address - Fax:540-468-3301
Practice Address - Street 1:240 MYERS MOON ROAD
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:VA
Practice Address - Zip Code:24465-2102
Practice Address - Country:US
Practice Address - Phone:540-468-3300
Practice Address - Fax:540-468-3301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-10
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007610548Medicaid