Provider Demographics
NPI:1609085489
Name:CATHOLIC PHYSICIAN'S GROUP L.L.C.
Entity Type:Organization
Organization Name:CATHOLIC PHYSICIAN'S GROUP L.L.C.
Other - Org Name:CHAD NICHOLAS HEINEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:NICHOLAS
Authorized Official - Last Name:HEINEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-984-5928
Mailing Address - Street 1:PO BOX 8397
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71910-8397
Mailing Address - Country:US
Mailing Address - Phone:501-984-5928
Mailing Address - Fax:
Practice Address - Street 1:4419 N HIGHWAY 7
Practice Address - Street 2:SUITE 201
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71909-9301
Practice Address - Country:US
Practice Address - Phone:501-984-5928
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARMC-2350207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5F018OtherAR BLUE CROSS & BLUE SHIE
ARMC-2350OtherAR LICENSE
AR5F018OtherAR BLUE CROSS & BLUE SHIE