1669408217 NPI number — JEFFREY A HEITMANN MD PA

Table of content: (NPI 1669408217)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669408217 NPI number — JEFFREY A HEITMANN MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JEFFREY A HEITMANN MD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
A WOMAN'S PLACE
Provider Other Organization Name Type Code:
3
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:
1669408217
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/25/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1660 MEDICAL BLVD
Provider Second Line Business Mailing Address:
#300
Provider Business Mailing Address City Name:
NAPLES
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34110-1413
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-513-0053
Provider Business Mailing Address Fax Number:
239-596-0900

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1660 MEDICAL BLVD
Provider Second Line Business Practice Location Address:
#300
Provider Business Practice Location Address City Name:
NAPLES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34110-1413
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-513-0053
Provider Business Practice Location Address Fax Number:
239-596-0900
Provider Enumeration Date:
06/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HEITMANN
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
239-513-0053

Provider Taxonomy Codes

  • Taxonomy code: 207VX0000X , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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