Provider Demographics
NPI:1093764938
Name:HERITAGE TECHNOLOGIES, LLC
Entity type:Organization
Organization Name:HERITAGE TECHNOLOGIES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:DINSDALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-834-7546
Mailing Address - Street 1:1855 N STAPLEY DR
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85203-3002
Mailing Address - Country:US
Mailing Address - Phone:480-834-7546
Mailing Address - Fax:480-833-8313
Practice Address - Street 1:1855 N STAPLEY DR
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85203-3002
Practice Address - Country:US
Practice Address - Phone:480-834-7546
Practice Address - Fax:480-833-8313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ633795Medicaid
AZZ25781Medicare PIN