Highland Clinic, a Prof Med Corp

Primary specialty

Non-Pharmacy Dispensing SiteTaxonomy code 332900000X

Legal business name

HIGHLAND CLINIC, A PROF MED CORP

Practice address

1455 E Bert Kouns Industrial Loop # 101
Shreveport, LA 71105-5634

Phone

(318) 798-4493

Fax

(318) 798-4450

NPI assigned

Dec 20, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Debbie W Smith

Title

Ceo

Phone

(318) 798-4598

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in LA

Enrollment records 1

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Highland Clinic, a Prof Med Corp

  • Multi-Specialty Clinic/Center
  • Shreveport, LA
  • NPI 1053315846

  3870493463

  Same PAC ID
• Highland Clinic, a Prof Med Corp

  • Orthopaedic Surgery Physician
  • Shreveport, LA
  • NPI 1700259678

  3870493463

  Same PAC ID
• Highland Clinic, a Prof Med Corp

  • Orthopaedic Surgery Physician
  • Bossier City, LA
  • NPI 1740897743

  3870493463

  Same PAC ID

Tax ID family

The Womens Clinic3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Highland Clinic, a Prof Med Corp

  • Orthopaedic Surgery Physician
  • Shreveport, LA
  • NPI 1700259678
  NPD tax ID
• Highland Clinic, a Prof Med Corp

  • Orthopaedic Surgery Physician
  • Bossier City, LA
  • NPI 1740897743
  NPD tax ID

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Gordon M Mead, MD

  • Orthopaedic Surgery Physician
  • Shreveport, LA
  • NPI 1518961317
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1387497600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1685404800000",
    "number": "1609297449",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1455 E BERT KOUNS INDUSTRIAL LOOP",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711055634",
            "telephone_number": "318-798-4539",
            "fax_number": "318-798-4601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1455 E BERT KOUNS INDUSTRIAL LOOP # 101",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711055634",
            "telephone_number": "318-798-4493",
            "fax_number": "318-798-4450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HIGHLAND CLINIC, A PROF MED CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-12-20",
        "last_updated": "2023-05-30",
        "certification_date": "2023-05-30",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "DEBBIE",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "318-798-4598"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "LA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Highland Clinic Pharmacy, LLC
• Highland Clinic, a Prof Med Corp
• Highland Clinic, a Prof Med Corp
• Highland Clinic, a Prof Med Corp
• Highland Clinic, a Prof Med Corp
• Highland Emergency Group, LLC
• Highland Wellness Center, LLC
• Julian Hightower, LMT

• Non-Pharmacy Dispensing Site in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Non-Pharmacy Dispensing Site in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.