Basic Information
| Provider Information | |||||||||
| NPI: | 1457388316 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HEAVNER | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | B | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6035 FAIRVIEW RD | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282103256 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7042953000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 13532 STEELECROFT PKWY | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282787545 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7042953475 | ||||||||
| FaxNumber: | 7042953476 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2006 | ||||||||
| LastUpdateDate: | 04/23/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | MD40839 | TN | N | Allopathic & Osteopathic Physicians | Otolaryngology | 207Y00000X | 200700368 | NC | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | 147TU | 01 | NC | BCBSNC | OTHER | 000000292751 | 01 | SC | UNISON HEALTH PLAN OF SC | OTHER | 5907396 | 05 | NC | MEDICAID | 20096068 | 01 | SC | SELECT HEALTH OF SC | OTHER | 4997345 | 01 | NC | CIGNA HEALTHCARE | OTHER | N68007 | 05 | SC | MEDICAID | 773189 | 01 | SC | WELLCARE | OTHER | P00751041 | 01 | RAILROAD MEDICARE | OTHER | 7494811 | 01 | NC | AETNA | OTHER |