Provider Demographics
NPI:1154588499
Name:HEATON FAMILY PRACTICE, LLC
Entity type:Organization
Organization Name:HEATON FAMILY PRACTICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:HEATON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:814-224-2213
Mailing Address - Street 1:100 NASON DR STE 103
Mailing Address - Street 2:
Mailing Address - City:ROARING SPRING
Mailing Address - State:PA
Mailing Address - Zip Code:16673-1201
Mailing Address - Country:US
Mailing Address - Phone:814-224-2213
Mailing Address - Fax:814-224-5879
Practice Address - Street 1:100 NASON DR STE 103
Practice Address - Street 2:
Practice Address - City:ROARING SPRING
Practice Address - State:PA
Practice Address - Zip Code:16673-1201
Practice Address - Country:US
Practice Address - Phone:814-224-2213
Practice Address - Fax:814-224-5879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS013765207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty