1518191097 NPI number — HEARTLAND MEDICAL SUPPLIES

Table of content: MASON WILLIAM HEFNER SKINNER DO (NPI 1972000735)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518191097 NPI number — HEARTLAND MEDICAL SUPPLIES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEARTLAND MEDICAL SUPPLIES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518191097
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/12/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13811 114TH AVE N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DAYTON
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55369
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-298-5518
Provider Business Mailing Address Fax Number:
263-425-7671

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13811 114TH AVE N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DAYTON
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55369
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-298-5518
Provider Business Practice Location Address Fax Number:
763-425-7671
Provider Enumeration Date:
05/12/2009

Additional Information

Authorized Official

Authorized Official Last Name:
KHARCHENKO
Authorized Official First Name:
LARISA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
612-298-5518

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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