Provider Demographics
NPI:1073518874
Name:HEIS, FOREST THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:FOREST
Middle Name:THOMAS
Last Name:HEIS
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 1:560 S LOOP RD
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:41017-3405
Mailing Address - Country:US
Mailing Address - Phone:859-301-2663
Mailing Address - Fax:859-817-7848
Practice Address - Street 1:2626 ALEXANDRIA PIKE STE 100
Practice Address - Street 2:
Practice Address - City:HIGHLAND HEIGHTS
Practice Address - State:KY
Practice Address - Zip Code:41076-1530
Practice Address - Country:US
Practice Address - Phone:859-301-2663
Practice Address - Fax:859-817-7848
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY37036207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYCB8861OtherRAILROAD MEDICARE
KY000000220822OtherANTHEM
KY611274265OtherTAX ID
KY64051758Medicaid
KY90008962OtherMEDICAID DME
KY200044815OtherRAILROAD MEDICARE
KY000000220822OtherANTHEM
OHH212940Medicare PIN
KY611274265OtherTAX ID
H58061Medicare UPIN