Provider Demographics
NPI:1497268312
Name:HIGHLAND EMERGENCY PHYSICIANS, PA
Entity Type:Organization
Organization Name:HIGHLAND EMERGENCY PHYSICIANS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:CLAYTON
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-288-2010
Mailing Address - Street 1:PO BOX 3488
Mailing Address - Street 2:DEPT # 05-143
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38803-3488
Mailing Address - Country:US
Mailing Address - Phone:601-288-2010
Mailing Address - Fax:
Practice Address - Street 1:130 HIGHLAND PKWY
Practice Address - Street 2:
Practice Address - City:PICAYUNE
Practice Address - State:MS
Practice Address - Zip Code:39466-5574
Practice Address - Country:US
Practice Address - Phone:601-358-9590
Practice Address - Fax:601-358-9594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-14
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty