Provider Demographics
NPI:1114417078
Name:HEARTLAND FOOT & ANKLE CLINIC PC
Entity type:Organization
Organization Name:HEARTLAND FOOT & ANKLE CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:KEVIN
Authorized Official - Last Name:HART
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:319-385-1128
Mailing Address - Street 1:PO BOX 497
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:IA
Mailing Address - Zip Code:52641-0497
Mailing Address - Country:US
Mailing Address - Phone:319-385-1128
Mailing Address - Fax:319-385-1129
Practice Address - Street 1:2850 MOUNT PLEASANT ST STE 103
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52601-2002
Practice Address - Country:US
Practice Address - Phone:319-753-1223
Practice Address - Fax:319-753-1171
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEARTLAND FOOT & ANKLE CLINIC PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-05-16
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00535213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty