Individual
DR. JIMMY D. HEATH JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
320 N LINCOLN ST, EAST PRAIRIE, MO 63845-1160
(573) 649-3026
(573) 649-5600
Mailing address
PO BOX 801143, KANSAS CITY, MO 64180-1143
(573) 331-5583
(573) 331-5079
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MDR5A39
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
124804
HEALTHLINK NUMBER
MO
05
—
201199429
—
MO
01
—
23178
BCBS MO NUMBER
MO
01
—
430741410
FIRST HEALTH NUMBER
MO
01
—
43074141063801A002
TRICARE
MO
Enumeration date
01/05/2006
Last updated
03/11/2021
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