1184784647 NPI number — STEPHEN H HEFFINGTON M.D.

Table of content: STEPHEN H HEFFINGTON M.D. (NPI 1184784647)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184784647 NPI number — STEPHEN H HEFFINGTON M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HEFFINGTON
Provider First Name:
STEPHEN
Provider Middle Name:
H
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:
1184784647
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/10/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2304 COUNTRY CLUB LN
Provider Second Line Business Mailing Address:
SUITE 303B
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38401-5172
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
931-334-1455
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1222 TROTWOOD AVE
Provider Second Line Business Practice Location Address:
SUITE 207
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38401-6436
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
931-840-5088
Provider Business Practice Location Address Fax Number:
931-840-5086
Provider Enumeration Date:
12/12/2006

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: 208800000X , with the licence number:  38435 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3725470 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3894624 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4086717 . This is a "BCBS TN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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