1841928660 NPI number — HEINEN MEDICAL CLINICS LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841928660 NPI number — HEINEN MEDICAL CLINICS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEINEN MEDICAL CLINICS LLC
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:
1841928660
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/10/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
151 LEON AVE STE B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EUNICE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70535-3938
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-457-8166
Provider Business Mailing Address Fax Number:
888-371-3069

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
325 NORTH 8TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KINDER
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70648
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-998-8151
Provider Business Practice Location Address Fax Number:
887-671-1263
Provider Enumeration Date:
08/10/2022

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HEINEN
Authorized Official First Name:
JADE
Authorized Official Middle Name:
NICHOLAS
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
337-457-8166

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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