Provider Demographics
NPI:1558507632
Name:JADE N. HEINEN, MD APMC
Entity type:Organization
Organization Name:JADE N. HEINEN, MD APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JADE
Authorized Official - Middle Name:NICHOLAS
Authorized Official - Last Name:HEINEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-457-8166
Mailing Address - Street 1:151 LEON ST
Mailing Address - Street 2:
Mailing Address - City:EUNICE
Mailing Address - State:LA
Mailing Address - Zip Code:70535-3917
Mailing Address - Country:US
Mailing Address - Phone:337-457-8166
Mailing Address - Fax:337-457-8564
Practice Address - Street 1:151 LEON ST
Practice Address - Street 2:
Practice Address - City:EUNICE
Practice Address - State:LA
Practice Address - Zip Code:70535-3917
Practice Address - Country:US
Practice Address - Phone:337-457-8166
Practice Address - Fax:337-457-8564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-19
Last Update Date:2008-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.201684207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty