Provider Demographics
NPI:1871734913
Name:HIGHLANDS MEDICAL PARTNERS I LLC
Entity type:Organization
Organization Name:HIGHLANDS MEDICAL PARTNERS I LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACKWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-886-7548
Mailing Address - Street 1:PO BOX 566
Mailing Address - Street 2:
Mailing Address - City:PRESTONSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41653-0566
Mailing Address - Country:US
Mailing Address - Phone:606-886-7094
Mailing Address - Fax:606-886-7092
Practice Address - Street 1:400 UNIVERSITY DR
Practice Address - Street 2:SUITE 102
Practice Address - City:PRESTONSBURG
Practice Address - State:KY
Practice Address - Zip Code:41653-1080
Practice Address - Country:US
Practice Address - Phone:606-886-7094
Practice Address - Fax:606-886-7092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-19
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory