Provider Demographics
NPI:1407638612
Name:ERIC HEALTHCARE
Entity Type:Organization
Organization Name:ERIC HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HAL
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:RICHINS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:208-993-0113
Mailing Address - Street 1:PO BOX 112
Mailing Address - Street 2:
Mailing Address - City:EAGAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85925-0112
Mailing Address - Country:US
Mailing Address - Phone:208-993-0113
Mailing Address - Fax:
Practice Address - Street 1:5448 HIGHWAY 260 STE 100
Practice Address - Street 2:
Practice Address - City:LAKESIDE
Practice Address - State:AZ
Practice Address - Zip Code:85929-5736
Practice Address - Country:US
Practice Address - Phone:928-358-1862
Practice Address - Fax:928-537-2049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty