1538227541 NPI number — BERNARD F HEILMAN M.D.

Table of content: BERNARD F HEILMAN M.D. (NPI 1538227541)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538227541 NPI number — BERNARD F HEILMAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HEILMAN
Provider First Name:
BERNARD
Provider Middle Name:
F
Provider Name Prefix Text:
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:
1538227541
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/22/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
323 SW 10TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MADISON
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57042-3200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-256-6551
Provider Business Mailing Address Fax Number:
605-256-6469

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
323 SW 10TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MADISON
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57042-3200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-256-6551
Provider Business Practice Location Address Fax Number:
605-256-6469
Provider Enumeration Date:
12/04/2006

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: 207Q00000X , with the licence number:  1349 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 15092 . This is a "MIDLAND" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 01-20637 . This is a "MEDICA" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 1349 . This is a "DAKOTA CARE" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 0005278 . This is a "WELLMARK BLUE CROSS/BS" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 0120637 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 1930 . This is a "AVERA HEALTH PLANS" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 5602622 . This is a "OTHER INSURANCE" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 20590 . This is a "SIOUX VALLEY HEALTH" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 5602622 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".




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