Provider Demographics
NPI:1306935713
Name:HEARTLAND LABORATORIES, INC.
Entity type:Organization
Organization Name:HEARTLAND LABORATORIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:LEISURE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-512-6118
Mailing Address - Street 1:520 S PIERCE AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-2749
Mailing Address - Country:US
Mailing Address - Phone:641-423-3140
Mailing Address - Fax:
Practice Address - Street 1:520 S PIERCE AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-2749
Practice Address - Country:US
Practice Address - Phone:641-423-3140
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAABCCPO1669335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier