MEDICARE: DR. ERIC J. HEATHERS M.D.

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	01044350A	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
7	P00141244	OTHER	IN	R.R. MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	562454401	OTHER	IN	SAGAMORE
2	562454401	OTHER	IN	M PLAN
3	562454401	OTHER	IN	AETNA
4	562454401	OTHER	IN	UNITED HEALTHCARE
5	562454401	OTHER	IN	TRICARE
6	562454401	OTHER	IN	ADVANTAGE HEALTHCARE
8	562454401	OTHER	IN	WASAU
9	000000342682	OTHER	IN	BLUE CROSS BLUE SHIELD
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
11	562454401	OTHER	IN	ENCORE
12	562454401	OTHER	IN	CIGNA
13	562454401	OTHER	IN	HUMANA
14	562454401	OTHER	IN	SUBURBAN HEALTH
15	562454401	OTHER	IN	AARP

General Provider Information

NPI Number	:	1972541126
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIC J. HEATHERS M.D.

Provider Business Mailing Address
First Line	:	3508 S LAFOUNTAIN ST
Second Line	:
City	:	KOKOMO
State	:	IN
Zip	:	46902-3803
Country	:	US
Telephone Number	:	765-864-5704
Fax Number	:	765-864-5720

Provider Business Practice Location Address
First Line	:	3508 S LAFOUNTAIN ST
Second Line	:
City	:	KOKOMO
State	:	IN
Zip	:	46902-3803
Country	:	US
Telephone Number	:	765-864-5704
Fax Number	:	765-864-5720

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

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	08/06/2019

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