1710037692 NPI number — MICHAEL HEID DO

Table of content: MICHAEL HEID DO (NPI 1710037692)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710037692 NPI number — MICHAEL HEID DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HEID
Provider First Name:
MICHAEL
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
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:
1710037692
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/18/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 11407
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35246-1431
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
361-572-0333
Provider Business Mailing Address Fax Number:
361-703-5101

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
801 E 6TH ST. STE. 602
Provider Second Line Business Practice Location Address:
BAYSIDE SURGICAL ASSOCIATES
Provider Business Practice Location Address City Name:
PANAMA CITY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-913-6960
Provider Business Practice Location Address Fax Number:
573-331-5079
Provider Enumeration Date:
01/11/2007

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: 208600000X , with the licence number:  2006023537 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086S0127X , with the licence number: OS7096 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086S0102X , with the licence number: OS7096 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1710037692 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 165402003 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 502944 . This is a "ANTHEM BCBS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 7100044890 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200184604 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 761287 . This is a "HEALTHLINK" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00433989 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 019719900 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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