Basic Information
| Provider Information | |||||||||
| NPI: | 1831147818 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LONGVAL | ||||||||
| FirstName: | HEATHER | ||||||||
| MiddleName: | N. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 814 PIERCE ST | ||||||||
| Address2: | STE 300 | ||||||||
| City: | SIOUX CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 511011058 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7122262600 | ||||||||
| FaxNumber: | 7122262605 | ||||||||
| Practice Location | |||||||||
| Address1: | 4545 SERGEANT RD | ||||||||
| Address2: | |||||||||
| City: | SIOUX CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 511064706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7122742400 | ||||||||
| FaxNumber: | 7122741487 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2006 | ||||||||
| LastUpdateDate: | 10/31/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 34717 | IA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 02848 | 01 | IA | WELLMARK - SINGING HILLS | OTHER | 36972 | 01 | IA | WELLMARK - MIDTOWN | OTHER | 7711490 | 05 | IA | MEDICAID | 10025306900 | 05 | IA | MEDICAID | 1288142 | 05 | IA | MEDICAID | 2288142 | 05 | IA | MEDICAID | 42128384914 | 05 | IA | MEDICAID | 7715660 | 05 | IA | MEDICAID |