# CITY OF HIGHLAND

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Highland Ambulance Service
- **Organization subpart:** No

## Provider details

- **NPI number:** 1750336756
- **Authorized official:** MRS. STEPHANIE L NICKLIN (BILLING)
- **Authorized official phone:** (618) 651-9801

## Contact information

- **Practice address:** 1122 BROADWAY, HIGHLAND, IL 62249-1917
- **Practice address phone:** (618) 654-5901
- **Practice address fax:** (618) 654-6829
- **Mailing address:** 2610 PLAZA DR, PO BOX 218, HIGHLAND, IL 62249-1123
- **Mailing address phone:** (618) 651-9801
- **Mailing address fax:** (618) 654-1901

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3416L0300X | Land Ambulance | 1690161 | IL | Yes |

## Other

- **Enumeration date:** 05/24/2006
- **Last updated:** 03/27/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0006019802 | BCBS OF IL | IL |
| 01 | — | 590155556 | MEDICARE RAILROAD | IL |