1922001437 NPI number — DR. TIMOTHY J HEYD M.D.

Table of content: DR. TIMOTHY J HEYD M.D. (NPI 1922001437)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922001437 NPI number — DR. TIMOTHY J HEYD M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HEYD
Provider First Name:
TIMOTHY
Provider Middle Name:
J
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:
1922001437
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/19/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9549 MONTGOMERY RD 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45242-7238
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-489-3737
Provider Business Mailing Address Fax Number:
513-984-3796

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
416 S EAST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEBANON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45036-2378
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-695-1228
Provider Business Practice Location Address Fax Number:
513-695-2941
Provider Enumeration Date:
05/30/2005

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: 207Q00000X , with the licence number:  34063863H , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0164398 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000374073 . This is a "UNICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000374073 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 421534506091 . This is a "CARESOURCE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 4262626 . This is a "AETNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: D6386303 . This is a "HUMANA/CHOICECARE" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: 080188836 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 203006 . This is a "NATIONWIDE HEALTH PLAN" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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