Provider Demographics
NPI:1689085466
Name:SEAN HEARN MD LLC
Entity type:Organization
Organization Name:SEAN HEARN MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY MEDICINE/ PSYCHOANALYST
Authorized Official - Prefix:DR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:TIMOTHY
Authorized Official - Last Name:HEARN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:651-246-8126
Mailing Address - Street 1:5 METATE DR
Mailing Address - Street 2:
Mailing Address - City:SANDIA PARK
Mailing Address - State:NM
Mailing Address - Zip Code:87047-8508
Mailing Address - Country:US
Mailing Address - Phone:651-246-8126
Mailing Address - Fax:
Practice Address - Street 1:5 METATE DR
Practice Address - Street 2:
Practice Address - City:SANDIA PARK
Practice Address - State:NM
Practice Address - Zip Code:87047-8508
Practice Address - Country:US
Practice Address - Phone:651-246-8126
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-14
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN35931261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN080017652Medicare UPIN