1700852076 NPI number — DR. BARRY D HEIN MD

Table of content: DR. BARRY D HEIN MD (NPI 1700852076)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700852076 NPI number — DR. BARRY D HEIN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HEIN
Provider First Name:
BARRY
Provider Middle Name:
D
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1700852076
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/07/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 820
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SIOUX FALLS
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57101-0820
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-940-7583
Provider Business Mailing Address Fax Number:
712-478-4086

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1305 W 18TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SIOUX FALLS
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57105-0401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-333-1000
Provider Business Practice Location Address Fax Number:
712-478-4086
Provider Enumeration Date:
02/27/2006

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: 207LP2900X , with the licence number:  37989 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207L00000X , with the licence number: 5746 , 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: 318688100 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 83G25HE . This is a "BCBS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 4994330 . This is a "BCBS" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: P00331398 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 0714097 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5701160 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".




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