Provider Demographics
NPI:1588879175
Name:DAVID HEANEY MD INC
Entity type:Organization
Organization Name:DAVID HEANEY MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOD: SECRETARY, ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:HEANEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-733-9707
Mailing Address - Street 1:515 W ACEQUIA AVE STE A
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-6131
Mailing Address - Country:US
Mailing Address - Phone:559-733-9707
Mailing Address - Fax:559-733-7009
Practice Address - Street 1:515 W ACEQUIA AVE STE A
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-6131
Practice Address - Country:US
Practice Address - Phone:559-733-9707
Practice Address - Fax:559-733-7009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00A301420207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A301420Medicaid
CA05D0864240OtherCLIA NUMBER
CA1013902733OtherNPPES - PRACTICING DR NPI
CA=========OtherTIN
CAA25982Medicare UPIN