Healthcare Provider Details

I. General information

NPI: 1346222395
Provider Name (Legal Business Name): HEATON, HEATON & JAY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 03/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 WILSON CREEK RD
LAWRENCEBURG IN
47025-2751
US

IV. Provider business mailing address

PO BOX 2
MILTON KY
40045-0002
US

V. Phone/Fax

Practice location:
  • Phone: 812-537-1010
  • Fax:
Mailing address:
  • Phone: 800-288-8325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. GREGORY HEATON
Title or Position: PRESIDENT
Credential: MD
Phone: 812-265-5211