Provider Demographics
NPI:1568791523
Name:HIGHLAND HEALTH CENTER, PLLC
Entity Type:Organization
Organization Name:HIGHLAND HEALTH CENTER, PLLC
Other - Org Name:HIGHLAND NEUROLOGY & INJURY ASSOCIATES, PLLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ATTENDING PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BLAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:LISNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-582-5555
Mailing Address - Street 1:720 BARRET AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40204-1750
Mailing Address - Country:US
Mailing Address - Phone:502-582-5555
Mailing Address - Fax:502-582-5556
Practice Address - Street 1:720 BARRET AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40204-1750
Practice Address - Country:US
Practice Address - Phone:502-582-5555
Practice Address - Fax:502-582-5556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-21
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3004162364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64253685Medicaid
KY78011525Medicaid