1013902733 NPI number — DR. DAVID J HEANEY M.D.

Table of content: DR. DAVID J HEANEY M.D. (NPI 1013902733)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013902733 NPI number — DR. DAVID J HEANEY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HEANEY
Provider First Name:
DAVID
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:
HEANEY
Provider Other First Name:
JOHN
Provider Other Middle Name:
DAVID
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1013902733
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/29/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
515 W ACEQUIA AVE STE A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VISALIA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93291-6131
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-733-9707
Provider Business Mailing Address Fax Number:
559-733-7009

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
515 W ACEQUIA AVE STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VISALIA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93291-6131
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-733-9707
Provider Business Practice Location Address Fax Number:
559-733-7009
Provider Enumeration Date:
09/19/2005

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: 207R00000X , with the licence number:  A301420 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RN0300X , with the licence number: A301420 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00A301420 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1013123686 . This is a "NPPES-TULARE LOCATION" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1972710127 . This is a "NPPES-PORTERVILLE LOC." identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 942512154 . This is a "FED TAX ID #" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 05D0864240 . This is a "CLIA NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1588879175 . This is a "NPPES-VISALIA LOCATION" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: A30142 . This is a "CALIF. MEDICAL BOARD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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