Provider Demographics
NPI:1275567299
Name:HEARTLAND MEDICAL SUPPLY INC
Entity Type:Organization
Organization Name:HEARTLAND MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:STRICKLAND
Authorized Official - Suffix:
Authorized Official - Credentials:RRT
Authorized Official - Phone:325-646-3439
Mailing Address - Street 1:1605 COGGIN AVENUE
Mailing Address - Street 2:
Mailing Address - City:BROWNWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76801
Mailing Address - Country:US
Mailing Address - Phone:325-646-3439
Mailing Address - Fax:325-643-6402
Practice Address - Street 1:1605 COGGIN AVENUE
Practice Address - Street 2:
Practice Address - City:BROWNWOOD
Practice Address - State:TX
Practice Address - Zip Code:76801
Practice Address - Country:US
Practice Address - Phone:325-646-3439
Practice Address - Fax:325-643-6402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0029181332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0371720001Medicare ID - Type Unspecified