Basic Information
| Provider Information | |||||||||
| NPI: | 1992808851 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HEMEYER | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3925 | ||||||||
| Address2: | |||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711333925 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8006840052 | ||||||||
| FaxNumber: | 4058441794 | ||||||||
| Practice Location | |||||||||
| Address1: | 1400 BRADEN ST | ||||||||
| Address2: | EMERGENCY DEPT | ||||||||
| City: | JACKSONVILLE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 720763721 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5019857000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2006 | ||||||||
| LastUpdateDate: | 06/19/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | R3197 | AR | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 124983001 | 05 | AR | MEDICAID | P00092046 | 01 | RAILROAD MEDICARE | OTHER | P01027357 | 01 | RAILROAD MCARE | OTHER |