MEDICARE: MRS. HEIDI M SIMS MSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	33004601A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	049912P	OTHER	IN	SIHO
2	000000202537	OTHER	IN	ANTHEM BCBS
3	12368	OTHER	IN	PHP

General Provider Information

NPI Number	:	1215930755
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HEIDI M SIMS MSW

Provider Business Mailing Address
First Line	:	5215 N BEND DR
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-1651
Country	:	US
Telephone Number	:	260-432-5181
Fax Number	:	260-432-5692

Provider Business Practice Location Address
First Line	:	5215 N BEND DR
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-1651
Country	:	US
Telephone Number	:	260-432-5181
Fax Number	:	260-432-5692

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/28/2005
Last Update Date	:	07/08/2007

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