Provider Demographics
NPI:1659795193
Name:HIGHLANDS HEALTHCARE, PLLC
Entity Type:Organization
Organization Name:HIGHLANDS HEALTHCARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBER
Authorized Official - Middle Name:J
Authorized Official - Last Name:LOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:931-528-6500
Mailing Address - Street 1:315 N WASHINGTON AVE
Mailing Address - Street 2:SUITE 175
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-2629
Mailing Address - Country:US
Mailing Address - Phone:931-520-6500
Mailing Address - Fax:931-528-1488
Practice Address - Street 1:315 N WASHINGTON AVE
Practice Address - Street 2:SUITE 175
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-2629
Practice Address - Country:US
Practice Address - Phone:931-520-6500
Practice Address - Fax:931-528-1488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-04
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty