Basic Information
Provider Information | |||||||||
NPI: | 1144460296 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | HEISINGER | ||||||||
FirstName: | ADAM | ||||||||
MiddleName: | JAMES | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | D.O. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 3290 | ||||||||
Address2: |   | ||||||||
City: | LA GRANDE | ||||||||
State: | OR | ||||||||
PostalCode: | 978507290 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5419638421 | ||||||||
FaxNumber: | 5419631476 | ||||||||
Practice Location | |||||||||
Address1: | 900 SUNSET DR | ||||||||
Address2: |   | ||||||||
City: | LA GRANDE | ||||||||
State: | OR | ||||||||
PostalCode: | 978501387 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5419638421 | ||||||||
FaxNumber: | 5419631476 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/03/2009 | ||||||||
LastUpdateDate: | 01/20/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 01/20/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 0102202485 | VA | N |   | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |   | 207X00000X | 58-002720 | OH | N |   | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |   | 207X00000X | DO187093 | OR | Y |   | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |   |
No ID Information.