Provider Demographics
NPI:1215536818
Name:HEARTLAND WEIGHT LOSS CLINIC, LLC
Entity Type:Organization
Organization Name:HEARTLAND WEIGHT LOSS CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:LEGRAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:573-803-2287
Mailing Address - Street 1:3095 LEXINGTON AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701-2629
Mailing Address - Country:US
Mailing Address - Phone:573-803-2287
Mailing Address - Fax:
Practice Address - Street 1:3095 LEXINGTON AVE STE 200
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-2629
Practice Address - Country:US
Practice Address - Phone:573-803-2287
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-23
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty