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Heather Lynn Autry

Family Medicine

Allopathic & Osteopathic Physicians

1500 S Main St, Fort Worth, TX 76104-4917

PECOS Enrollment

This provider is enrolled in PECOS as HEATHER AUTRY.

Based on the most recent information from CMS, provider Heather Lynn Autry is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 3 days ago.

Profile Details

Provider ID
1093979395
Provider Type
Individual
Full Name
Autry, Heather Lynn
Title
Dr.
Credential
D.O.

Gender
Female
Sole Proprietor
No
Enumeration Date
7/15/2008
Last Updated
6/4/2016

Contact Information

Practice Location

1500 S Main St, Fort Worth, TX 76104-4917

(817) 702-3431

Unlisted Fax

Mailing Location

PO Box 732973, Dallas, TX 75391-2973

(817) 702-3431

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 207Q00000X Primary	Description Family Medicine Allopathic & Osteopathic Physicians	License N953 Texas
Code 207Q00000X	Description Family Medicine Allopathic & Osteopathic Physicians	License 51402 Colorado
Code 207QS0010X	Description Family Medicine Allopathic & Osteopathic Physicians	License 51402 Colorado

Provider Identifiers

ID	Description	Issuer
ID 64771202	Description Medicaid	Issuer Unlisted Colorado
ID COA107693	Description Other	Issuer MEDICARE PTAN Colorado

Heather Lynn Autry

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Code

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Provider Identifiers

ID

Description

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ID

Description

Issuer

ID

Description

Issuer

Slee, Barbara Lynn

Robinson, Amber Thomas

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Greer, Daria Katherine

Savage, Autumn

Lasater, Loren S

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Amber Rogers, Md, Pllc

Higginbotham, John M.