Provider Demographics
NPI:1326437492
Name:HEIDI A HEROLD, MD INC
Entity Type:Organization
Organization Name:HEIDI A HEROLD, MD INC
Other - Org Name:HEIDI HEROLD,M.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-241-7477
Mailing Address - Street 1:2143 AIRPARK DR
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-2447
Mailing Address - Country:US
Mailing Address - Phone:530-241-7477
Mailing Address - Fax:530-241-7877
Practice Address - Street 1:2143 AIRPARK DR
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-2447
Practice Address - Country:US
Practice Address - Phone:530-241-7477
Practice Address - Fax:530-241-7877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-13
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA86057207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA134965Medicare UPIN