NPIMap

Organization Active NPI

Jack Heethouse DO PLLC

  • Orthopaedic Surgery Physician
  • Muskegon, MI
National Provider Identifier
1538354964
Registry record updated Nov 6, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
5101012999 Issued in MI
Legal business name
JACK HEETHOUSE DO PLLC
Practice address
1675 Leahy St
Suite 120
Muskegon, MI 49442-5500
Phone
(231) 722-7245
Fax
(231) 722-6103
NPI assigned
Sep 10, 2007
Last updated
Nov 6, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 6, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Jack W Heethouse, DO
Title
Owner
Phone
(231) 722-7245

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X 5101012999 MI Primary

Addresses

Primary practice location

1675 Leahy St
Suite 120
Muskegon, MI 49442-5500

Mailing address

1675 Leahy St
Suite 120
Muskegon, MI 49442-5500
Phone (231) 722-7245

Other identifiers 1

IdentifierTypeStateIssuer
4308380MedicaidMI

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1189382400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1194307200000",
    "number": "1538354964",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1675 LEAHY ST",
            "address_2": "SUITE 120",
            "city": "MUSKEGON",
            "state": "MI",
            "postal_code": "494425500",
            "telephone_number": "231-722-7245",
            "fax_number": "231-722-6103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1675 LEAHY ST",
            "address_2": "SUITE 120",
            "city": "MUSKEGON",
            "state": "MI",
            "postal_code": "494425500",
            "telephone_number": "231-722-7245",
            "fax_number": "231-722-6103"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACK HEETHOUSE DO PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-10",
        "last_updated": "2007-11-06",
        "status": "A",
        "authorized_official_last_name": "HEETHOUSE",
        "authorized_official_first_name": "JACK",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "231-722-7245",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "MI",
            "license": "5101012999",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4308380",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Muskegon, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.