Provider Demographics
NPI:1285715730
Name:HIGGINS, FRED
Entity type:Individual
Prefix:MR
First Name:FRED
Middle Name:
Last Name:HIGGINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2127 EDSEL LN NW
Mailing Address - Street 2:
Mailing Address - City:CORYDON
Mailing Address - State:IN
Mailing Address - Zip Code:47112-2030
Mailing Address - Country:US
Mailing Address - Phone:812-738-1707
Mailing Address - Fax:812-738-9054
Practice Address - Street 1:2127 EDSEL LN NW
Practice Address - Street 2:
Practice Address - City:CORYDON
Practice Address - State:IN
Practice Address - Zip Code:47112-2030
Practice Address - Country:US
Practice Address - Phone:812-738-1707
Practice Address - Fax:812-738-9054
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200277370Medicaid
IN352101814OtherTAX ID#
IN1319480001Medicare NSC