Provider Demographics
NPI:1235533829
Name:HEEKIN CLINIC LLC
Entity Type:Organization
Organization Name:HEEKIN CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FADY
Authorized Official - Middle Name:
Authorized Official - Last Name:EL BAHRI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-328-5979
Mailing Address - Street 1:1045 RIVERSIDE AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-4148
Mailing Address - Country:US
Mailing Address - Phone:904-328-5979
Mailing Address - Fax:904-619-9925
Practice Address - Street 1:1045 RIVERSIDE AVE STE 100
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-4148
Practice Address - Country:US
Practice Address - Phone:904-328-5979
Practice Address - Fax:904-619-9925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-10
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207X00000X
FLME49020207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic SurgeryGroup - Single Specialty