Provider Demographics
NPI:1528271152
Name:EDDS, ERIC M (MD)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:M
Last Name:EDDS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:THE MEDICAL CENTER @ FRANKLIN
Mailing Address - Street 2:1100 BROOKHAVEN ROAD
Mailing Address - City:FRANKLIN
Mailing Address - State:KY
Mailing Address - Zip Code:42134-2746
Mailing Address - Country:US
Mailing Address - Phone:270-598-4800
Mailing Address - Fax:931-552-6663
Practice Address - Street 1:THE MEDICAL CENTER @ FRANKLIN
Practice Address - Street 2:1100 BROOKHAVEN ROAD
Practice Address - City:FRANKLIN
Practice Address - State:KY
Practice Address - Zip Code:42134-2746
Practice Address - Country:US
Practice Address - Phone:270-598-4800
Practice Address - Fax:931-552-6663
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01060222A2085R0202X, 2085U0001X
MO20120202042085R0202X
KY420842085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000532350OtherANTHEM BCBS
KY7100263600Medicaid
IN200870120Medicaid
IA24598Medicaid
INP00452678OtherRAILROAD MEDICARE
INP00742709OtherRAILROAD MEDICARE
KYP01199200OtherKY RR MEDICARE
INP00452678OtherRAILROAD MEDICARE
KY7100263600Medicaid
IN219950D6Medicare PIN