Provider Demographics
NPI:1326002031
Name:HEARTLAND PULMONARY & INTERNAL MEDICINE, PA
Entity Type:Organization
Organization Name:HEARTLAND PULMONARY & INTERNAL MEDICINE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:MESIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-242-4465
Mailing Address - Street 1:1428 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:KS
Mailing Address - Zip Code:66067-3547
Mailing Address - Country:US
Mailing Address - Phone:785-242-4465
Mailing Address - Fax:785-242-0211
Practice Address - Street 1:1428 S MAIN ST
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:KS
Practice Address - Zip Code:66067-3543
Practice Address - Country:US
Practice Address - Phone:785-242-4465
Practice Address - Fax:785-242-0211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0424612207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS24371010OtherBC/BS OF KANSAS CITY
KS110129Medicare ID - Type UnspecifiedALSO BC/BS OF KS GROUP #