Provider Demographics
NPI:1992992960
Name:HEARTLAND MEDICAL SERVICES LLC
Entity type:Organization
Organization Name:HEARTLAND MEDICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:E
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:918-493-6460
Mailing Address - Street 1:8352 S VANDALIA AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-1910
Mailing Address - Country:US
Mailing Address - Phone:918-493-6460
Mailing Address - Fax:918-493-6430
Practice Address - Street 1:8352 S VANDALIA AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-1910
Practice Address - Country:US
Practice Address - Phone:918-493-6460
Practice Address - Fax:918-493-6430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-03
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty