Healthcare Provider Details

I. General information

NPI: 1023277944
Provider Name (Legal Business Name): HERITAGE HILLS FAMILY MEDICINE, P.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2008
Last Update Date: 10/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9218 KIMMER DR SUITE 102
LONE TREE CO
80124-6732
US

IV. Provider business mailing address

9218 KIMMER DR SUITE 102
LONE TREE CO
80124-6732
US

V. Phone/Fax

Practice location:
  • Phone: 303-792-3333
  • Fax: 303-792-3361
Mailing address:
  • Phone: 303-792-3333
  • Fax: 303-792-3361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number37249
License Number StateCO

VIII. Authorized Official

Name: ANDREAS J EDRICH
Title or Position: OWNER
Credential: M.D.
Phone: 303-792-3333