Provider Demographics
NPI:1215999156
Name:RENAL CONSULTANTS
Entity type:Organization
Organization Name:RENAL CONSULTANTS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:KEVIN
Authorized Official - Last Name:HEIFNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-664-9881
Mailing Address - Street 1:9601 BAPTIST HEALTH DR STE 400
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-6399
Mailing Address - Country:US
Mailing Address - Phone:501-224-2141
Mailing Address - Fax:501-224-0506
Practice Address - Street 1:9601 BAPTIST HEALTH DR STE 400
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6399
Practice Address - Country:US
Practice Address - Phone:501-224-2141
Practice Address - Fax:501-224-0506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-05
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR117288002Medicaid