Provider Demographics
NPI:1497712533
Name:HIGHLAND DISTRICT HOSPITAL PROFESSIONAL SERVICES CORPORATION
Entity Type:Organization
Organization Name:HIGHLAND DISTRICT HOSPITAL PROFESSIONAL SERVICES CORPORATION
Other - Org Name:GREENFIELD MEDICAL SERVICES HDH PSC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF PROFESSIONAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:COOMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-393-6100
Mailing Address - Street 1:1275 N HIGH ST
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45133-8273
Mailing Address - Country:US
Mailing Address - Phone:937-393-6100
Mailing Address - Fax:937-393-1658
Practice Address - Street 1:1092 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:OH
Practice Address - Zip Code:45123-8319
Practice Address - Country:US
Practice Address - Phone:937-981-1121
Practice Address - Fax:937-981-5660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-01
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2355053Medicaid
OH363844Medicare ID - Type UnspecifiedRHC CLINIC