Provider Demographics
NPI:1225348212
Name:HEARTLAND OB/GYN LLC
Entity Type:Organization
Organization Name:HEARTLAND OB/GYN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LYLIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:FAHMY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-933-7274
Mailing Address - Street 1:4951 CENTER ST
Mailing Address - Street 2:#206
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68106-3251
Mailing Address - Country:US
Mailing Address - Phone:402-933-7247
Mailing Address - Fax:402-933-7196
Practice Address - Street 1:4951 CENTER ST
Practice Address - Street 2:#206
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68106-3251
Practice Address - Country:US
Practice Address - Phone:402-933-7247
Practice Address - Fax:402-933-7196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-08
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025907600Medicaid
IAIB1932Medicare PIN
NA1716Medicare PIN