Provider Demographics
NPI:1023277944
Name:HERITAGE HILLS FAMILY MEDICINE, P.C
Entity type:Organization
Organization Name:HERITAGE HILLS FAMILY MEDICINE, P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:EDRICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-792-3333
Mailing Address - Street 1:9218 KIMMER DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-6732
Mailing Address - Country:US
Mailing Address - Phone:303-792-3333
Mailing Address - Fax:303-792-3361
Practice Address - Street 1:9218 KIMMER DR
Practice Address - Street 2:SUITE 102
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-6732
Practice Address - Country:US
Practice Address - Phone:303-792-3333
Practice Address - Fax:303-792-3361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-05
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO37249282N00000X
207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No282N00000XHospitalsGeneral Acute Care HospitalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO28230779Medicaid
COC484958Medicare UPIN
CO28230779Medicaid
COC484958Medicare PIN