Provider Demographics
NPI:1497706659
Name:HIGHLAND HOSPITAL ASSOCIATION
Entity Type:Organization
Organization Name:HIGHLAND HOSPITAL ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:H
Authorized Official - Last Name:DISSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-348-1401
Mailing Address - Street 1:300 56TH ST SE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-2308
Mailing Address - Country:US
Mailing Address - Phone:304-926-1600
Mailing Address - Fax:304-926-1649
Practice Address - Street 1:300 56TH ST SE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-2308
Practice Address - Country:US
Practice Address - Phone:304-926-1600
Practice Address - Fax:304-926-1649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-13
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV151283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0001254001Medicaid
WVG56715Medicare UPIN
WVA17933Medicare UPIN
WVA72041Medicare UPIN
WVI23253Medicare UPIN
WV0001254001Medicaid
WVG66285Medicare UPIN
WV514001Medicare Oscar/Certification