MEDICARE: CLIFFORD W HEINRICH, P.C.

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	207Q00000X	Family Medicine Physician	3295	AZ

General Provider Information

NPI Number	:	1588781652
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLIFFORD W HEINRICH, P.C.

Provider Business Mailing Address
First Line	:	3031 W NORTHERN AVE
Second Line	:	SUITE 111
City	:	PHOENIX
State	:	AZ
Zip	:	85051-6694
Country	:	US
Telephone Number	:	602-246-0756
Fax Number	:	602-246-1980

Provider Business Practice Location Address
First Line	:	2211 E HIGHLAND AVE
Second Line	:	SUITE 105
City	:	PHOENIX
State	:	AZ
Zip	:	85016-4835
Country	:	US
Telephone Number	:	602-954-1502
Fax Number	:	602-954-1504

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. CLIFFORD W HEINRICH III
Credential	:	D.O.
Telephone Number	:	602-954-1502

Provider Enumeration Date	:	03/23/2007
Last Update Date	:	07/09/2010

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