Provider Demographics
NPI:1104398973
Name:HEISER CONSTRUCTION AND DEVELOPMENT CORP
Entity Type:Organization
Organization Name:HEISER CONSTRUCTION AND DEVELOPMENT CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:HEISER
Authorized Official - Suffix:
Authorized Official - Credentials:HIS
Authorized Official - Phone:928-855-5252
Mailing Address - Street 1:1930 MESQUITE AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-5772
Mailing Address - Country:US
Mailing Address - Phone:928-855-5252
Mailing Address - Fax:928-855-5252
Practice Address - Street 1:1930 MESQUITE AVE STE 5
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-5772
Practice Address - Country:US
Practice Address - Phone:928-855-5252
Practice Address - Fax:928-855-5252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-18
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment