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NPI Code Detail

MEDICARE: MARK REID HECKLE MD

MEDICARE:   MARK REID HECKLE  MD
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
1207R00000XInternal Medicine PhysicianMD0000054973TN
2207RC0000XCardiovascular Disease Physician54973TN
3390200000XStudent in an Organized Health Care Education/Training Program
4207RC0001XClinical Cardiac Electrophysiology Physician54973TN

General Provider Information

NPI Number : 1497190862
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK REID HECKLE MD
Provider Business Mailing Address
First Line : 1211 UNION AVE STE 330
Second Line :
City : MEMPHIS
State : TN
Zip : 38104-6655
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 57 GERMANTOWN CT STE 100
Second Line :
City : CORDOVA
State : TN
Zip : 38018-4274
Country : US
Telephone Number : 901-435-8550
Fax Number : 901-478-0781
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/30/2013
Last Update Date : 05/17/2024

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