| Beverly A Heinking, D.o. | |
|
300 Pinewood Dr Sw Live Oak FL 32064-4029 | |
| (386) 362-1014 | |
| (386) 362-5076 |
| Full Name | Beverly A Heinking, D.o. |
|---|---|
| Speciality | Family Medicine |
| Location | 300 Pinewood Dr Sw, Live Oak, Florida |
| Authorized Official Name and Position | Beverly Ann Heinking (OWNER) |
| Authorized Official Contact | 3863621014 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Beverly A Heinking, D.o. 300 Pinewood Dr Sw Live Oak FL 32064-4029 Ph: (386) 362-1014 | Beverly A Heinking, D.o. 300 Pinewood Dr Sw Live Oak FL 32064-4029 Ph: (386) 362-1014 |
| NPI Number | 1700998010 |
|---|---|
| Provider Enumeration Date | 08/31/2006 |
| Last Update Date | 07/02/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700998010 | NPI | - | NPPES |
| 051350402 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | OS5866 (Florida) | Primary |
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