Healthcare Provider Details

I. General information

NPI: 1407638612
Provider Name (Legal Business Name): ERIC HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2023
Last Update Date: 10/23/2023
Certification Date: 10/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5448 HIGHWAY 260 STE 100
LAKESIDE AZ
85929-5736
US

IV. Provider business mailing address

PO BOX 112
EAGAR AZ
85925-0112
US

V. Phone/Fax

Practice location:
  • Phone: 928-358-1862
  • Fax: 928-537-2049
Mailing address:
  • Phone: 208-993-0113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. HAL THOMAS RICHINS JR.
Title or Position: OWNER/OPERATOR
Credential: MD
Phone: 208-993-0113