Provider Demographics
NPI:1164478137
Name:HEARTLAND FAMILY MEDICINE, P.C.
Entity Type:Organization
Organization Name:HEARTLAND FAMILY MEDICINE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANTON
Authorized Official - Middle Name:J
Authorized Official - Last Name:SMOLIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:308-928-2103
Mailing Address - Street 1:PO BOX 665
Mailing Address - Street 2:
Mailing Address - City:ALMA
Mailing Address - State:NE
Mailing Address - Zip Code:68920-0665
Mailing Address - Country:US
Mailing Address - Phone:308-928-2103
Mailing Address - Fax:308-928-2560
Practice Address - Street 1:715 BROWN ST
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:NE
Practice Address - Zip Code:68920-2132
Practice Address - Country:US
Practice Address - Phone:308-928-2103
Practice Address - Fax:308-928-2560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEDF1336OtherRAILROAD MEDICARE
NE10025412200Medicaid
KS200422030AMedicaid
NE10025411700Medicaid
NE5898590001Medicare NSC
NE099806Medicare PIN