Provider Demographics
NPI:1588622575
Name:HEINEN FAMILY MEDICINE
Entity Type:Organization
Organization Name:HEINEN FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:P
Authorized Official - Last Name:HEINEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-477-5988
Mailing Address - Street 1:PO BOX 15
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70602-0015
Mailing Address - Country:US
Mailing Address - Phone:337-477-5988
Mailing Address - Fax:
Practice Address - Street 1:3845 BROOKFLOWER CIRCLE LN
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-0292
Practice Address - Country:US
Practice Address - Phone:337-477-5988
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4385507860OtherBCBS
LA1053368Medicaid
5CR98Medicare ID - Type Unspecified
LA4385507860OtherBCBS