Provider Demographics
NPI:1417068867
Name:HEIFETZ & PALMER, MD'S, A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:HEIFETZ & PALMER, MD'S, A MEDICAL CORPORATION
Other - Org Name:SIERRA NEVADA ONCOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURENCE
Authorized Official - Middle Name:J
Authorized Official - Last Name:HEIFETZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-582-6450
Mailing Address - Street 1:PO BOX 26525
Mailing Address - Street 2:SECTION #3051
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73126-0525
Mailing Address - Country:US
Mailing Address - Phone:918-806-1024
Mailing Address - Fax:918-286-7381
Practice Address - Street 1:10956 DONNER PASS RD
Practice Address - Street 2:SUITE 210
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161-4861
Practice Address - Country:US
Practice Address - Phone:530-582-6450
Practice Address - Fax:530-550-8169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G263410Medicaid
CAZZZ03648ZMedicare ID - Type Unspecified