1659529311 NPI number — HEARTLAND FOOT & ANKLE ASSOCIATES PC

Table of content: (NPI 1659529311)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659529311 NPI number — HEARTLAND FOOT & ANKLE ASSOCIATES PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEARTLAND FOOT & ANKLE ASSOCIATES PC
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:
1659529311
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/01/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10 HEARTLAND DR
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
BLOOMINGTON
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61704-7741
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
309-661-9975
Provider Business Mailing Address Fax Number:
309-661-9920

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10 HEARTLAND DR
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
BLOOMINGTON
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61704-7775
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
309-661-9975
Provider Business Practice Location Address Fax Number:
309-661-9920
Provider Enumeration Date:
09/05/2008

Additional Information

Authorized Official

Authorized Official Last Name:
LOCKWOOD
Authorized Official First Name:
MELISSA
Authorized Official Middle Name:
JOMARIE
Authorized Official Title or Position:
OWNER/PRESIDENT
Authorized Official Telephone Number:
309-661-9975

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  016.005357 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0732240001 . This is a "DMERC # WITH PPG" identifier . This identifiers is of the category "OTHER".
  • Identifier: 016005357 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com