Provider Demographics
NPI:1972522837
Name:PAUL M HEIMBECKER MD PA
Entity Type:Organization
Organization Name:PAUL M HEIMBECKER MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:A
Authorized Official - Last Name:HEIMBECKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-776-7640
Mailing Address - Street 1:127 N STEELE ST
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27330-3917
Mailing Address - Country:US
Mailing Address - Phone:919-776-7640
Mailing Address - Fax:919-776-2956
Practice Address - Street 1:127 N STEELE ST
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-3917
Practice Address - Country:US
Practice Address - Phone:919-776-7640
Practice Address - Fax:919-776-2956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9400524207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC016V6OtherBLUE CROSS
2331038OtherMEDICARE
NCDB4222OtherRR MEDICARE