Healthcare Provider Details

I. General information

NPI: 1861444143
Provider Name (Legal Business Name): BEVERLY HECK BIERBACH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VAMC, ENT SURGERY 1501 SAN PEDRO, SE
ALBUQUERQUE NM
87108-5153
US

IV. Provider business mailing address

51 ROCK RIDGE DR NE
ALBUQUERQUE NM
87122-2006
US

V. Phone/Fax

Practice location:
  • Phone: 505-265-1711
  • Fax: 505-256-5450
Mailing address:
  • Phone: 505-822-0658
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number1013169
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: