Healthcare Provider Details

I. General information

NPI: 1023381555
Provider Name (Legal Business Name): HEAVENS MEDICAL PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2012
Last Update Date: 11/13/2025
Certification Date: 11/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4450 S RURAL RD STE A210
TEMPE AZ
85282-5587
US

IV. Provider business mailing address

105 S DELAWARE DR STE 1
APACHE JUNCTION AZ
85120-6512
US

V. Phone/Fax

Practice location:
  • Phone: 623-444-2734
  • Fax:
Mailing address:
  • Phone: 623-444-2734
  • Fax: 623-444-2784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JASON PERNELL HEAVENS
Title or Position: PRESIDENT
Credential: MD
Phone: 480-399-6440