Provider Demographics
NPI:1225427180
Name:HEARTLAND SERVICE GROUP
Entity Type:Organization
Organization Name:HEARTLAND SERVICE GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ABDULAHI
Authorized Official - Middle Name:ALI
Authorized Official - Last Name:OSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-548-2095
Mailing Address - Street 1:248 OAK DR
Mailing Address - Street 2:
Mailing Address - City:EAGLE LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:56024-3404
Mailing Address - Country:US
Mailing Address - Phone:734-548-2095
Mailing Address - Fax:
Practice Address - Street 1:248 OAK DR
Practice Address - Street 2:
Practice Address - City:EAGLE LAKE
Practice Address - State:MN
Practice Address - Zip Code:56024-3404
Practice Address - Country:US
Practice Address - Phone:734-548-2095
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-15
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN791703400022343800000X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No343800000XTransportation ServicesSecured Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN172A00000XOtherMEDICAL TRANSPORTATION
MN171W00000XOtherTRANSPORTATION