Provider Demographics
NPI:1497713424
Name:HEARTLAND ORTHOPEDIC CLINIC PC
Entity Type:Organization
Organization Name:HEARTLAND ORTHOPEDIC CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:MACRANDALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:605-333-0400
Mailing Address - Street 1:1727 S CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57103-3245
Mailing Address - Country:US
Mailing Address - Phone:605-333-0400
Mailing Address - Fax:605-333-4875
Practice Address - Street 1:1727 S CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57103-3245
Practice Address - Country:US
Practice Address - Phone:605-333-0400
Practice Address - Fax:605-333-4875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-01
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1990077Medicaid
117042OtherUCARE
SD6400372Medicaid
MN759072500Medicaid
MNM200001063Medicare PIN
117042OtherUCARE
SDD25443Medicare UPIN
IA1990077Medicaid