1255776415 NPI number — HEARTLAND O&P INC.

Table of content: (NPI 1255776415)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255776415 NPI number — HEARTLAND O&P INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEARTLAND O&P INC.
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:
1255776415
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/15/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1163
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARKANSAS CITY
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67005-1163
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
620-402-6789
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22215 TUPPER STREET
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
WINFIELD
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67156
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-402-6789
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/01/2013

Additional Information

Authorized Official

Authorized Official Last Name:
PITTS
Authorized Official First Name:
JOSHUA
Authorized Official Middle Name:
BLAINE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
620-402-6789

Provider Taxonomy Codes

  • Taxonomy code: 332BC3200X , with the licence number:  C.P.O. 2980 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: C.P.O.2980 . This is a "AMERICAN BOARD OF CERTIFICATION FOR ORTHOTICS AND PROSTHETICS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com