Provider Demographics
NPI:1932529922
Name:DAVID HEINE, MD
Entity type:Organization
Organization Name:DAVID HEINE, MD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:HEINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:563-382-1200
Mailing Address - Street 1:PO BOX 96
Mailing Address - Street 2:911 S. MILL STREET
Mailing Address - City:DECORAH
Mailing Address - State:IA
Mailing Address - Zip Code:52101-0096
Mailing Address - Country:US
Mailing Address - Phone:563-382-1200
Mailing Address - Fax:563-382-1211
Practice Address - Street 1:911 S MILL ST
Practice Address - Street 2:
Practice Address - City:DECORAH
Practice Address - State:IA
Practice Address - Zip Code:52101-2023
Practice Address - Country:US
Practice Address - Phone:563-382-1200
Practice Address - Fax:563-382-1211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-17
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care