Provider Demographics
NPI:1326100074
Name:HEART HEALTH CENTER PC
Entity Type:Organization
Organization Name:HEART HEALTH CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:HAYNES
Authorized Official - Last Name:HEATON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-766-8570
Mailing Address - Street 1:201 E DR HICKS BLVD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-5767
Mailing Address - Country:US
Mailing Address - Phone:256-766-8570
Mailing Address - Fax:256-766-5183
Practice Address - Street 1:201 E DR HICKS BLVD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-5767
Practice Address - Country:US
Practice Address - Phone:256-766-8570
Practice Address - Fax:256-766-5183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4281751Medicaid
AL529603430Medicaid
CC8294OtherPALMETTO GBA RR MEDICARE
TN4281751Medicaid
ALI700Medicare ID - Type UnspecifiedAL MEDICARE
ALI137Medicare ID - Type UnspecifiedAL MEDICARE
AL529603430Medicaid
ALI138Medicare ID - Type UnspecifiedAL MEDICARE