Provider Demographics
NPI:1316175151
Name:THE HEIDI GROUP
Entity type:Organization
Organization Name:THE HEIDI GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED NURSE-MIDWIFE
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:GLASS
Authorized Official - Suffix:
Authorized Official - Credentials:RN, CNM
Authorized Official - Phone:817-366-8817
Mailing Address - Street 1:351 W JEFFERSON BLVD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-4859
Mailing Address - Country:US
Mailing Address - Phone:214-637-7775
Mailing Address - Fax:214-637-7704
Practice Address - Street 1:1 CHISHOLM TRL
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-5008
Practice Address - Country:US
Practice Address - Phone:512-255-2088
Practice Address - Fax:512-255-2582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-01
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX577527367A00000X
251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251V00000XAgenciesVoluntary or CharitableGroup - Single Specialty
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Single Specialty