Healthcare Provider Details

I. General information

NPI: 1194931428
Provider Name (Legal Business Name): JEFFREY D. HEUERMANN BC-HIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 07/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8600 WARD PKWY SUITE 2080
KANSAS CITY MO
64114-2614
US

IV. Provider business mailing address

6 VICTORY DR
LIBERTY MO
64068-3807
US

V. Phone/Fax

Practice location:
  • Phone: 816-444-4547
  • Fax: 816-444-2892
Mailing address:
  • Phone: 816-313-2800
  • Fax: 816-792-9819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number948
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number889
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: