Basic Information
| Provider Information | |||||||||
| NPI: | 1881980605 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STORTS | ||||||||
| FirstName: | ERIC | ||||||||
| MiddleName: | C. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.P.M. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 272 HOSPITAL RD | ||||||||
| Address2: | |||||||||
| City: | CHILLICOTHE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 456019031 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7407794598 | ||||||||
| FaxNumber: | 7407794599 | ||||||||
| Practice Location | |||||||||
| Address1: | 4437 STATE ROUTE 159 STE G15 | ||||||||
| Address2: | |||||||||
| City: | CHILLICOTHE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 456017065 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7407794598 | ||||||||
| FaxNumber: | 7407794599 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2011 | ||||||||
| LastUpdateDate: | 11/24/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213E00000X | 000933 | CT | N | Podiatric Medicine & Surgery Service Providers | Podiatrist | 213ES0131X | 000933 | CT | N | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot Surgery | 213E00000X | 36.003794 | OH | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist | 213ES0103X | 000933 | CT | N | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
ID Information
| ID | Type | State | Issuer | Description | 0200837 | 05 | OH | MEDICAID |