1215399167 NPI number — DR HEINLENS HEALTH CARE CLINIC PLLC

Table of content: (NPI 1215399167)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215399167 NPI number — DR HEINLENS HEALTH CARE CLINIC PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR HEINLENS HEALTH CARE CLINIC PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1215399167
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/28/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 136
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TROUT LAKE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49793-0136
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-304-1343
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
806 N STATE ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
STANTON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48888-9708
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
616-459-0898
Provider Business Practice Location Address Fax Number:
616-459-6963
Provider Enumeration Date:
03/21/2016

Additional Information

Authorized Official

Authorized Official Last Name:
HEINLEN
Authorized Official First Name:
LENE
Authorized Official Middle Name:
ANNETTE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
989-304-1343

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  5101015385 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: MI9687 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com