Organization
KEVIN T HEATON DO PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEANNETTE L GANSBERG (EXECUTIVE DIRECTOR)
(541) 274-2902
Entity
Organization
Contact information
Practice address
2200 BRYANT WILLIAMS DR, SUITE 1, KLAMATH FALLS, OR 97601-1120
(541) 884-7746
(541) 884-0848
Mailing address
2200 BRYANT WILLIAMS DR, SUITE 1, KLAMATH FALLS, OR 97601-1120
(541) 884-7746
(541) 884-0848
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
DO22887
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
287483
—
OR
01
—
4604977397601
TRICARE
OR
01
—
831170000
BLUE CROSS
OR
01
—
DG2430
RAIL ROAD MEDICARE
OR
01
—
XPY195175
MEDICAL
CA
Enumeration date
04/26/2007
Last updated
03/07/2023
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