1679574578 NPI number — HEARTLAND PSYCHOLOGICAL SERVICES

Table of content: (NPI 1679574578)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679574578 NPI number — HEARTLAND PSYCHOLOGICAL SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEARTLAND PSYCHOLOGICAL SERVICES
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:
1679574578
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
904 W 23RD ST
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
YANKTON
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57078-1216
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-665-0841
Provider Business Mailing Address Fax Number:
605-665-0096

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
904 W 23RD ST
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
YANKTON
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57078-1216
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-665-0841
Provider Business Practice Location Address Fax Number:
605-665-0096
Provider Enumeration Date:
08/02/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BLACKINTON
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
G
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
605-665-0841

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  2118 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 101YM0800X , with the licence number: 2127 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 103TC0700X , with the licence number: 250 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 103TC0700X , with the licence number: 456 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 103TC0700X , with the licence number: 401 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 2084P0800X , with the licence number: 1845 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 6552242 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6551632 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6576050 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0007251 . This is a "BC BS GROUP PROVIDER #" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 6575780 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6550552 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100763 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9171289 . This is a "DAKOTA CARE GROUP #" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".




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