1275524795 NPI number — DR. TODD ALLEN HEYING OD

Table of content: DR. TODD ALLEN HEYING OD (NPI 1275524795)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275524795 NPI number — DR. TODD ALLEN HEYING OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HEYING
Provider First Name:
TODD
Provider Middle Name:
ALLEN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
OD
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:
1275524795
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4207 GLASS RD NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CEDAR RAPIDS
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52402
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
319-366-4455
Provider Business Mailing Address Fax Number:
319-362-8461

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4207 GLASS RD NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CEDAR RAPIDS
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52402
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-366-4455
Provider Business Practice Location Address Fax Number:
319-362-8461
Provider Enumeration Date:
11/03/2005

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: 152W00000X , with the licence number:  2109 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2140688 . This is a "FIRST HEALTH" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 5597774 . This is a "AETNA US HEALTHCARE" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: IA0102 . This is a "JOHN DEERE HEALTH" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 7719 . This is a "MIDLANDS CHOICE" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 45861 . This is a "WELLMARK BLUECROSS BLUE S" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 1178434 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4011190001 . This is a "DMEKC CIGNA MEDICARE" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com