Provider Demographics
NPI:1124593900
Name:HEINEN MEDICAL CLINICS LLC
Entity Type:Organization
Organization Name:HEINEN MEDICAL CLINICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JADE
Authorized Official - Middle Name:NICHOLAS
Authorized Official - Last Name:HEINEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-457-8166
Mailing Address - Street 1:151 LEON AVE
Mailing Address - Street 2:
Mailing Address - City:EUNICE
Mailing Address - State:LA
Mailing Address - Zip Code:70535-3937
Mailing Address - Country:US
Mailing Address - Phone:337-457-8166
Mailing Address - Fax:888-371-3069
Practice Address - Street 1:151 LEON AVE STE B
Practice Address - Street 2:
Practice Address - City:EUNICE
Practice Address - State:LA
Practice Address - Zip Code:70535-3938
Practice Address - Country:US
Practice Address - Phone:337-457-8166
Practice Address - Fax:888-371-3069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-09
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health