Provider Demographics
NPI: | 1629685557 |
---|---|
Name: | HIGHLAND GYNECOLOGY PLLC |
Entity Type: | Organization |
Organization Name: | HIGHLAND GYNECOLOGY PLLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER/PHYSICIAN |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | RACHAEL |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | HAVERLAND |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 325-665-1643 |
Mailing Address - Street 1: | 4400 BUFFALO GAP RD STE 2400C |
Mailing Address - Street 2: | |
Mailing Address - City: | ABILENE |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 79606-2723 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 253-695-4133 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1680 ANTILLEY RD STE 350 |
Practice Address - Street 2: | |
Practice Address - City: | ABILENE |
Practice Address - State: | TX |
Practice Address - Zip Code: | 79606-5266 |
Practice Address - Country: | US |
Practice Address - Phone: | 325-704-5200 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2020-09-24 |
Last Update Date: | 2020-09-24 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207VF0040X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Female Pelvic Medicine and Reconstructive Surgery | Group - Single Specialty |