1265439954 NPI number — DR. DAVID E HEAPE M.D.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265439954 NPI number — DR. DAVID E HEAPE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HEAPE
Provider First Name:
DAVID
Provider Middle Name:
E
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265439954
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/25/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 11407
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35246-0100
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-313-5258
Provider Business Mailing Address Fax Number:
205-313-5298

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
298 MEMORAL DRIVE
Provider Second Line Business Practice Location Address:
OCONEE MEMORIAL HOSPITAL
Provider Business Practice Location Address City Name:
SENECA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29672
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-313-5258
Provider Business Practice Location Address Fax Number:
205-313-5298
Provider Enumeration Date:
07/07/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  32170 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: G34360 . This is a "SOUTH CAROLINA MEDICAID #" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 27499 . This is a "BCBSF GRP# 98513" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 253093700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 606478700 . This is a "DOL GRP#" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: G34360 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 32170 . This is a "SOUTH CAROLINA MEDICAL LICENSE" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".




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