Aric Jay Eckhardt, M.D., S.C.

Primary specialty

Plastic Surgery PhysicianTaxonomy code 208200000X

License

036099360 Issued in IL

Legal business name

ARIC JAY ECKHARDT, M.D., S.C.

Practice address

3900 28TH Avenue Dr
Suite 105
Moline, IL 61265-5536

Phone

(309) 764-4650

Fax

(866) 633-1827

NPI assigned

Apr 16, 2008

Last updated

Nov 25, 2013By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Aric Jay Eckhardt, M.D., F.A.C.S.NPI 1730156647

Title

President/Owner

Phone

(309) 764-4650

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Aric J Eckhardt, MD

  • Plastic Surgery Physician
  • Moline, IL
  • NPI 1730156647
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1208304000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1385337600000",
    "number": "1053585513",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3900 28TH AVENUE DR",
            "address_2": "SUITE 105",
            "city": "MOLINE",
            "state": "IL",
            "postal_code": "612655536",
            "telephone_number": "309-764-4650",
            "fax_number": "866-633-1827"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3900 28TH AVENUE DR",
            "address_2": "SUITE 105",
            "city": "MOLINE",
            "state": "IL",
            "postal_code": "612655536",
            "telephone_number": "309-764-4650",
            "fax_number": "866-633-1827"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ARIC JAY ECKHARDT, M.D., S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-16",
        "last_updated": "2013-11-25",
        "status": "A",
        "authorized_official_last_name": "ECKHARDT",
        "authorized_official_first_name": "ARIC",
        "authorized_official_middle_name": "JAY",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "309-764-4650",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D., F.A.C.S."
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "IL",
            "license": "036099360",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036099360",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Plastic Surgery Physician in Moline, IL
• Providers in Moline, IL by specialty
• Plastic Surgery Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.