MEDICARE: LESLIE N. HEDDLESTON 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	207VM0101X	Maternal & Fetal Medicine Physician	3758	SD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1639240732	OTHER	SD	ARAZ/AMERICA'S PPO
2	283761009502	OTHER	SD	PREFERRED ONE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	HP30795	OTHER	SD	HEALTHPARTNERS
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	1658	OTHER	SD	MIDLANDS CHOICE
7	3758	OTHER	SD	SD STATE LICENSE
8	G54151	OTHER	CA	CALIFORNIA STATE LICENSE
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
11	3758	OTHER	SD	DAKOTACARE
12	4993265	OTHER	SD	BLUE CROSS
13	370624200	OTHER	SD	DEPT OF LABOR
14	57105AD06	OTHER	SD	WPS TRICARE
15	658C9HE	OTHER	MN	BLUE CROSS
16	658C9HE	OTHER	MN	CC SYSTEMS/ BLUE PLUS
17	924114229808	OTHER	MN	PRIMEWEST
18	1639240732	OTHER	SD	MEDICA

General Provider Information

NPI Number	:	1639240732
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLIE N. HEDDLESTON MD

Provider Business Mailing Address
First Line	:	PO BOX 86370
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57118-6370
Country	:	US
Telephone Number	:	605-322-7510
Fax Number	:

Provider Business Practice Location Address
First Line	:	1417 S CLIFF AVE
Second Line	:	STE 100
City	:	SIOUX FALLS
State	:	SD
Zip	:	57105-1063
Country	:	US
Telephone Number	:	605-322-8937
Fax Number	:	605-322-8938

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

Provider Enumeration Date	:	11/11/2006
Last Update Date	:	10/10/2018

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