Basic Information
| Provider Information | |||||||||
| NPI: | 1326025412 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HEARTLAND RADIOLOGY, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 459 | ||||||||
| Address2: | |||||||||
| City: | POPLAR BLUFF | ||||||||
| State: | MO | ||||||||
| PostalCode: | 639020459 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5732227441 | ||||||||
| FaxNumber: | 5732227441 | ||||||||
| Practice Location | |||||||||
| Address1: | 221 PHYSICIANS PARK | ||||||||
| Address2: | |||||||||
| City: | POPLAR BLUFF | ||||||||
| State: | MO | ||||||||
| PostalCode: | 639013956 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5737279080 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/29/2005 | ||||||||
| LastUpdateDate: | 09/09/2009 | ||||||||
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| AuthorizedOfficialLastName: | ALMOND | ||||||||
| AuthorizedOfficialFirstName: | DONNA | ||||||||
| AuthorizedOfficialMiddleName: | L. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5732227441 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 142630002 | 05 | AR | MEDICAID | 222143 | 01 | HEALTHLINK INC. | OTHER | 241702646 | 05 | MO | MEDICAID | DO3729 | 01 | MO | RAILROAD MEDICARE | OTHER | 130569 | 01 | MO | BCBS | OTHER | 1600702 | 01 | UNITED HEALTHCARE | OTHER | 655009 | 01 | FIRST HEALTH | OTHER | CH4567 | 01 | MO | RAILROAD MEDICARE | OTHER |