# HEINEN FAMILY MEDICINE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1588622575
- **Authorized official:** DAVID P HEINEN MD (OWNER)
- **Authorized official phone:** (337) 477-5988

## Contact information

- **Practice address:** 3845 BROOKFLOWER CIRCLE LN, LAKE CHARLES, LA 70605-0292
- **Practice address phone:** (337) 477-5988
- **Mailing address:** PO BOX 15, LAKE CHARLES, LA 70602-0015
- **Mailing address phone:** (337) 477-5988

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 363LF0000X | Family Nurse Practitioner | — | NULL | — |
| 363LF0000X | Family Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 05/02/2006
- **Last updated:** 06/15/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1053368 | — | LA |
| 01 | — | 4385507860 | BCBS | LA |