Provider Demographics
NPI:1235311374
Name:HENRY M HELLER, MD, PC
Entity Type:Organization
Organization Name:HENRY M HELLER, MD, PC
Other - Org Name:DBA FOUR CORNERS ONCOLOGY HEMATOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:M
Authorized Official - Last Name:HELLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-247-3993
Mailing Address - Street 1:1800 E 3RD AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-5016
Mailing Address - Country:US
Mailing Address - Phone:970-247-3993
Mailing Address - Fax:970-247-0902
Practice Address - Street 1:1800 E 3RD AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-5016
Practice Address - Country:US
Practice Address - Phone:970-247-3993
Practice Address - Fax:970-247-0902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-30
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO22830174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCG3935OtherRAILROAD MEDICARE
COCG3935OtherRAILROAD MEDICARE
COCG8308Medicare PIN
GACG3935Medicare PIN