Provider Demographics
NPI:1982058590
Name:HEINE, HEINE AND BOWLES, PLLC
Entity Type:Organization
Organization Name:HEINE, HEINE AND BOWLES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:J
Authorized Official - Last Name:SHUTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-554-2026
Mailing Address - Street 1:2850 LONE OAK RD STE 5
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-8043
Mailing Address - Country:US
Mailing Address - Phone:270-554-2026
Mailing Address - Fax:270-554-9164
Practice Address - Street 1:2850 LONE OAK RD STE 5
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-8043
Practice Address - Country:US
Practice Address - Phone:270-554-2026
Practice Address - Fax:270-554-9164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-20
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty