Provider Demographics
NPI:1134442544
Name:MARK T HELLNER MD INC
Entity type:Organization
Organization Name:MARK T HELLNER MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:HELLNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-388-0730
Mailing Address - Street 1:900 W OLIVE AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95348-2401
Mailing Address - Country:US
Mailing Address - Phone:209-388-0730
Mailing Address - Fax:209-388-0731
Practice Address - Street 1:900 W OLIVE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348-2401
Practice Address - Country:US
Practice Address - Phone:209-388-0730
Practice Address - Fax:209-388-0731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-12
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG52055207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G520550Medicaid
CA00G520550Medicare PIN
CA00G520550Medicaid
CADC581AMedicare PIN