1841276144 NPI number — MR. MICHAEL E HEIL O.D.

Table of content: MR. MICHAEL E HEIL O.D. (NPI 1841276144)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841276144 NPI number — MR. MICHAEL E HEIL O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HEIL
Provider First Name:
MICHAEL
Provider Middle Name:
E
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
O.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:
1841276144
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/14/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2505 S 38TH ST
Provider Second Line Business Mailing Address:
SUITE A-108
Provider Business Mailing Address City Name:
TACOMA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98409-7375
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-472-1188
Provider Business Mailing Address Fax Number:
253-472-3594

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2505 S 38TH ST
Provider Second Line Business Practice Location Address:
SUITE A-108
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98409-7375
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-472-1188
Provider Business Practice Location Address Fax Number:
253-472-3594
Provider Enumeration Date:
12/19/2005

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: 152W00000X , with the licence number:  OD00001426TX , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: G8889818 . This is a "MEDICARE PTAN SOUTH CENTER" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 2003416 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: G8889817 . This is a "MEDACARE PIN SOUTH CENTER" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: GAB16987 . This is a "MEDICARE PTAN TACOMA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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