Provider Demographics
NPI:1295835247
Name:HEARTLAND ORTHOPEDIC SPECIALISTS
Entity Type:Organization
Organization Name:HEARTLAND ORTHOPEDIC SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:DOYLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-762-1144
Mailing Address - Street 1:111 17TH AVE E
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ALEXANDRIA
Mailing Address - State:MN
Mailing Address - Zip Code:56308-3734
Mailing Address - Country:US
Mailing Address - Phone:320-762-1144
Mailing Address - Fax:320-762-1935
Practice Address - Street 1:111 17TH AVE E
Practice Address - Street 2:SUITE 101
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-3703
Practice Address - Country:US
Practice Address - Phone:320-762-1144
Practice Address - Fax:320-762-1935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN564OtherLICENSE
30701054OtherPRIMEWEST
104667OtherUCARE
MN888210000Medicaid
61006ALOtherBC/BS
MNCP4310OtherTRAVELERS MEDICARE
104667OtherUCARE
MNC07810Medicare PIN