MEDICARE: DR. ROBERT W HEIDEPRIEM 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
1	2086S0129X	Vascular Surgery Physician	109337	GA
2	2086S0129X	Vascular Surgery Physician	00023846	AL
3	2086S0129X	Vascular Surgery Physician	ME159968	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	P00381059	OTHER	AL	RR MEDICARE
8	1700875	OTHER	AL	MEDICARE COMPLETE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1700875	OTHER	AL	UNITED HEALTHCARE
2	H85594	OTHER	AL	VIVA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	51590936	OTHER	AL	BLUE CROSS- SHELBY
6	208500240	OTHER	AL	AETNA
7	51540027	OTHER	AL	BLUE CROSS-TRINITY
9	2081367	OTHER	AL	CIGNA
10	51544310	OTHER	AL	BLUE CROSS - PRINCETON
11	51539627	OTHER	AL	BLUE CROSS-
12	51540026	OTHER	AL	BLUE CROSS- ST VINCENTS
13	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619959673
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT W HEIDEPRIEM MD

Provider Business Mailing Address
First Line	:	1300 MEDICAL DR
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32308-4646
Country	:	US
Telephone Number	:	850-216-0100
Fax Number	:

Provider Business Practice Location Address
First Line	:	705 17TH ST STE 200
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31901-3507
Country	:	US
Telephone Number	:	706-660-2485
Fax Number	:

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

Provider Enumeration Date	:	11/16/2005
Last Update Date	:	02/03/2026

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