Provider Demographics
NPI:1265437222
Name:HEARNSBERGER, JOHN E (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:E
Last Name:HEARNSBERGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 MEDICAL CIR STE 200
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:71852-8608
Mailing Address - Country:US
Mailing Address - Phone:870-845-8914
Mailing Address - Fax:870-845-8910
Practice Address - Street 1:132 MEDICAL CIR STE 200
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:AR
Practice Address - Zip Code:71852-8608
Practice Address - Country:US
Practice Address - Phone:870-845-8914
Practice Address - Fax:870-845-8910
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC 4722208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARP00076358OtherRAIL ROAD MEDICARE
AR15288000001OtherQUAL CHOICE
AR52291OtherARKANSAS BLUE CROSS BLUE
AR770351101OtherARKANSAS BREAST CARE
AR102674001Medicaid
ARP00076358OtherRAIL ROAD MEDICARE
AR52291Medicare PIN