Provider Demographics
NPI:1407497936
Name:HERITAGE INNOVATIONS LLC
Entity Type:Organization
Organization Name:HERITAGE INNOVATIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING ANALYST
Authorized Official - Prefix:MR
Authorized Official - First Name:EDGAR
Authorized Official - Middle Name:
Authorized Official - Last Name:TIJERINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-805-5027
Mailing Address - Street 1:7700 MAIN ST STE 365
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-4456
Mailing Address - Country:US
Mailing Address - Phone:346-250-2595
Mailing Address - Fax:
Practice Address - Street 1:7700 MAIN ST STE 365
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4456
Practice Address - Country:US
Practice Address - Phone:346-250-2595
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-07
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty