1255398061 NPI number — DR. DANIEL A HEIMBECKER MD

Table of content: DR. DANIEL A HEIMBECKER MD (NPI 1255398061)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255398061 NPI number — DR. DANIEL A HEIMBECKER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HEIMBECKER
Provider First Name:
DANIEL
Provider Middle Name:
A
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:
1255398061
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/04/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1506 FLOYD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN ANGELO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76904-9009
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
325-212-5364
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
608 AVENUE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BALLINGER
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76821-2406
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
325-365-2531
Provider Business Practice Location Address Fax Number:
325-365-2662
Provider Enumeration Date:
04/26/2006

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: 207P00000X , with the licence number:  F8153 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207Q00000X , with the licence number: F8153 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 137702014 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 137702006 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8P9630 . This is a "BLUE CROSS/BLUESHIELD TX" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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