MEDICARE: LISA E HEICHBERGER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	23284	SC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	080185243	OTHER	SC	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	5944657	OTHER	SC	CIGNA

General Provider Information

NPI Number	:	1730166430
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA E HEICHBERGER MD

Provider Business Mailing Address
First Line	:	PO BOX 3239
Second Line	:
City	:	FLORENCE
State	:	SC
Zip	:	29502-3239
Country	:	US
Telephone Number	:	803-435-5270
Fax Number	:	803-433-0154

Provider Business Practice Location Address
First Line	:	50 E HOSPITAL ST STE 4
Second Line	:
City	:	MANNING
State	:	SC
Zip	:	29102-3149
Country	:	US
Telephone Number	:	803-435-8828
Fax Number	:	803-435-2239

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/23/2005
Last Update Date	:	03/31/2021

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Directions to “ LISA E HEICHBERGER MD” Practice Location

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