MEDICARE: DAVID W. HEFNER D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	OS010332L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568421477
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID W. HEFNER D.O.

Provider Business Mailing Address
First Line	:	675 N BROAD STREET EXT
Second Line	:	SUITE 5
City	:	GROVE CITY
State	:	PA
Zip	:	16127-5805
Country	:	US
Telephone Number	:	724-458-5872
Fax Number	:	724-458-5972

Provider Business Practice Location Address
First Line	:	675 N BROAD STREET EXT
Second Line	:	SUITE 5
City	:	GROVE CITY
State	:	PA
Zip	:	16127-5805
Country	:	US
Telephone Number	:	724-458-5872
Fax Number	:	724-458-5972

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/20/2006
Last Update Date	:	03/01/2010

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Directions to “ DAVID W. HEFNER D.O.” Practice Location

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