Provider Demographics
NPI:1326387432
Name:HEARTLAND MEDICAL SUPPLIES
Entity Type:Organization
Organization Name:HEARTLAND MEDICAL SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEWAYNE
Authorized Official - Middle Name:M
Authorized Official - Last Name:TENTLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-516-7396
Mailing Address - Street 1:115 7TH ST STE 207
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61104-1224
Mailing Address - Country:US
Mailing Address - Phone:815-516-7396
Mailing Address - Fax:
Practice Address - Street 1:115 7TH ST STE 207
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61104-1224
Practice Address - Country:US
Practice Address - Phone:815-516-7396
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-08
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies