Provider Demographics
NPI:1033386859
Name:HEARTLAND DIAGNOSTIC SERVICES LLC
Entity Type:Organization
Organization Name:HEARTLAND DIAGNOSTIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HOADLEY
Authorized Official - Middle Name:H
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:701-499-4807
Mailing Address - Street 1:3280 20TH ST S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-5917
Mailing Address - Country:US
Mailing Address - Phone:701-499-4807
Mailing Address - Fax:701-293-7408
Practice Address - Street 1:3280 20TH ST S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-5917
Practice Address - Country:US
Practice Address - Phone:701-499-4807
Practice Address - Fax:701-293-7408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-12
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiographyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN600R3HEOtherMN BLUE SHIELD
ND024761OtherND BLUE SHIELD
MN695294100Medicaid
ND13493Medicaid
ND024761OtherND BLUE SHIELD