Basic Information
| Provider Information | |||||||||
| NPI: | 1659356970 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HEATWOLE | ||||||||
| FirstName: | STANLEY | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 304 COLLEGE CIR | ||||||||
| Address2: | |||||||||
| City: | STAUNTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 244012311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5408867450 | ||||||||
| FaxNumber: | 5408864932 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 HEALTH CIR | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 244502448 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5404583300 | ||||||||
| FaxNumber: | 5404583366 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/09/2005 | ||||||||
| LastUpdateDate: | 06/02/2008 | ||||||||
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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 | 207P00000X | 0101018611 | VA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 005856817 | 05 | VA | MEDICAID |