Provider Demographics
NPI:1588781652
Name:CLIFFORD W HEINRICH, P.C.
Entity type:Organization
Organization Name:CLIFFORD W HEINRICH, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CLIFFORD
Authorized Official - Middle Name:W
Authorized Official - Last Name:HEINRICH
Authorized Official - Suffix:III
Authorized Official - Credentials:DO
Authorized Official - Phone:602-954-1502
Mailing Address - Street 1:3031 W NORTHERN AVE
Mailing Address - Street 2:SUITE 111
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85051-6694
Mailing Address - Country:US
Mailing Address - Phone:602-246-0756
Mailing Address - Fax:602-246-1980
Practice Address - Street 1:2211 E HIGHLAND AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-4835
Practice Address - Country:US
Practice Address - Phone:602-954-1502
Practice Address - Fax:602-954-1504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3295207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ=========OtherTAX ID NUMBER
AZ=========OtherTAX ID NUMBER