Provider Demographics
NPI:1972710127
Name:DAVID HEANEY, M.D., INC.
Entity type:Organization
Organization Name:DAVID HEANEY, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOD: SECRETARY - ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:BROOKSHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-733-9707
Mailing Address - Street 1:1120 N CHINOWTH ST
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-7896
Mailing Address - Country:US
Mailing Address - Phone:559-733-9707
Mailing Address - Fax:
Practice Address - Street 1:515 W PUTNAM AVE
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-3256
Practice Address - Country:US
Practice Address - Phone:559-783-1363
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30142207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A301420Medicaid
CA1013902733OtherNPPES - PRACTICING DR NPI
CA00A301420Medicaid
CA00A301420Medicare PIN