Provider Demographics
NPI:1376652305
Name:HEARTLAND ORTHOPEDIC SERVICES INC
Entity Type:Organization
Organization Name:HEARTLAND ORTHOPEDIC SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:H
Authorized Official - Last Name:CIESLAK
Authorized Official - Suffix:
Authorized Official - Credentials:CP LPO FAAOP
Authorized Official - Phone:815-754-9900
Mailing Address - Street 1:1967 DEKALB AVE
Mailing Address - Street 2:
Mailing Address - City:SYCAMORE
Mailing Address - State:IL
Mailing Address - Zip Code:60178-3107
Mailing Address - Country:US
Mailing Address - Phone:815-754-9900
Mailing Address - Fax:815-754-2040
Practice Address - Street 1:1967 DEKALB AVE
Practice Address - Street 2:
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-3107
Practice Address - Country:US
Practice Address - Phone:815-754-9900
Practice Address - Fax:815-754-2040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL335E00000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL1258370001Medicare ID - Type Unspecified