Provider Demographics
NPI:1386674786
Name:HEARTLAND ONCOLOGY & HEMATOLOGY, PLLC
Entity Type:Organization
Organization Name:HEARTLAND ONCOLOGY & HEMATOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PENNY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MALCOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-322-4136
Mailing Address - Street 1:1 EDMUNDSON PL
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-4658
Mailing Address - Country:US
Mailing Address - Phone:712-322-4136
Mailing Address - Fax:712-322-8129
Practice Address - Street 1:1 EDMUNDSON PL
Practice Address - Street 2:SUITE 100
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-4658
Practice Address - Country:US
Practice Address - Phone:712-322-4136
Practice Address - Fax:712-322-8129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA9701207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAG9534OtherRR MEDICARE
IA0197939Medicaid
IAG9534OtherRR MEDICARE