Provider Demographics
NPI:1073679940
Name:HEIBEL DERMATOLOGY CLINIC LLC
Entity type:Organization
Organization Name:HEIBEL DERMATOLOGY CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:D
Authorized Official - Last Name:HEIBEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-488-6969
Mailing Address - Street 1:7701 PRESERVE LN
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-4473
Mailing Address - Country:US
Mailing Address - Phone:402-488-6969
Mailing Address - Fax:402-488-6911
Practice Address - Street 1:7701 PRESERVE LN
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-4473
Practice Address - Country:US
Practice Address - Phone:402-488-6969
Practice Address - Fax:402-488-6911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE18056207NI0002X, 207NS0135X, 207ND0900X, 207ND0101X, 207NP0225X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No207NI0002XAllopathic & Osteopathic PhysiciansDermatologyClinical & Laboratory Dermatological ImmunologyGroup - Single Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Single Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty
No207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric DermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE35672OtherBLUE CROSS BLUE SHIELD
NECK4980OtherPALMETTO-RAILROAD MEDICAR
NE=========00Medicaid
NE35672OtherBLUE CROSS BLUE SHIELD
NEF93898Medicare UPIN