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General NPI Number Information
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NPI Number | 1407497936
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Entity Type | Organization
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Legal Business Name | HERITAGE INNOVATIONS LLC
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Dates
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Enumeration Date | 10/07/2019
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Last Update Date | 11/24/2020
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Provider Practice Location Address
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Address Line | 7700 MAIN ST STE 365
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City | HOUSTON
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State | TX
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Zip | 77030-4456
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Country | US
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Telephone | 346-250-2595
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Fax |
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Provider Business Mailing Address
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Address Line | 7700 MAIN ST STE 365
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City | HOUSTON
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State | TX
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Zip | 77030-4456
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Country | US
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Telephone | 346-250-2595
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Fax |
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Authorized Official
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Title or Position | BILLING ANALYST
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Name | MR. EDGAR TIJERINA
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Credential |
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Telephone | 713-805-5027
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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