Provider Demographics
NPI:1518182872
Name:HEARTLAND FOOT & ANKLE CLINIC PC
Entity Type:Organization
Organization Name:HEARTLAND FOOT & ANKLE CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:K
Authorized Official - Last Name:HART
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:319-385-1128
Mailing Address - Street 1:PO BOX 497
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:IA
Mailing Address - Zip Code:52641-0497
Mailing Address - Country:US
Mailing Address - Phone:319-385-1128
Mailing Address - Fax:319-385-1129
Practice Address - Street 1:209 S WHITE ST
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:IA
Practice Address - Zip Code:52641-2157
Practice Address - Country:US
Practice Address - Phone:319-385-1128
Practice Address - Fax:319-385-1129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00535332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA41870OtherBLUE CROSS
IA2101345OtherMEDICAID
IA2101345OtherMEDICAID
IA41870Medicare PIN
IA3894960001Medicare NSC