Provider Demographics
NPI:1477879807
Name:STEPHEN A HEIM
Entity Type:Organization
Organization Name:STEPHEN A HEIM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:HEIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:479-522-0832
Mailing Address - Street 1:PO BOX 11684
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72917-1684
Mailing Address - Country:US
Mailing Address - Phone:479-462-7803
Mailing Address - Fax:888-577-9955
Practice Address - Street 1:4901 E VALLEY RD
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-3545
Practice Address - Country:US
Practice Address - Phone:479-462-7803
Practice Address - Fax:888-577-9955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-09
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC6421207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARD79485Medicare UPIN