Active NPI
Highlands Medical Corp
- Family Medicine Physician
- Connellsville, PA
National Provider Identifier
1639115637
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- Legal business name
- HIGHLANDS MEDICAL CORP
- Practice address
- 2620 Memorial Blvd
Connellsville, PA 15425-1488 - Phone
- (724) 626-0700
- Fax
- (724) 626-8700
- NPI assigned
- Jun 20, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- William Kozak Jr., M.D.
- Title
- Owner/Physician
- Phone
- (724) 626-0700
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | Primary |
Addresses
Primary practice location
2620 Memorial Blvd
Connellsville, PA 15425-1488
Mailing address
506 Athena Dr
Delmont, PA 15626-1005
Phone (724) 468-6869
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1014902030001 | Medicaid | PA |
National Provider Directory
National Provider DirectoryLocations
2620 Memorial Blvd
Ste C
Connellsville, PA 15425
Phone (724) 626-0700
2620 Memorial Blvd
Connellsville, PA 15425
Phone (724) 626-0700
Interoperability endpoints
- https://api.platform.athenahealth.com/15116/brand/1/csg/1/fhir/r4
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150761600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1598054400000",
"number": "1639115637",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "506 ATHENA DR",
"city": "DELMONT",
"state": "PA",
"postal_code": "156261005",
"telephone_number": "724-468-6869",
"fax_number": "724-468-6207"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2620 MEMORIAL BLVD",
"city": "CONNELLSVILLE",
"state": "PA",
"postal_code": "154251488",
"telephone_number": "724-626-0700",
"fax_number": "724-626-8700"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "HIGHLANDS MEDICAL CORP",
"organizational_subpart": "NO",
"enumeration_date": "2006-06-20",
"last_updated": "2020-08-22",
"status": "A",
"authorized_official_last_name": "KOZAK",
"authorized_official_first_name": "WILLIAM",
"authorized_official_title_or_position": "OWNER/PHYSICIAN",
"authorized_official_telephone_number": "724-626-0700",
"authorized_official_name_suffix": "Jr.",
"authorized_official_credential": "M.D."
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Family Medicine",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1014902030001",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Connellsville, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.