Healthcare Provider Details

I. General information

NPI: 1417468281
Provider Name (Legal Business Name): HEFFERNAN ENTERPRISES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2017
Last Update Date: 10/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1527 SUPERIOR ST
WEBSTER CITY IA
50595-2961
US

IV. Provider business mailing address

902 1ST ST
WEBSTER CITY IA
50595-2002
US

V. Phone/Fax

Practice location:
  • Phone: 515-832-3033
  • Fax:
Mailing address:
  • Phone: 515-293-0026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number072381
License Number StateIA

VIII. Authorized Official

Name: DR. KYLE MARTIN HEFFERNAN
Title or Position: VICE PRESIDENT
Credential: DC
Phone: 515-293-0026