Provider Demographics
NPI:1518191097
Name:HEARTLAND MEDICAL SUPPLIES
Entity Type:Organization
Organization Name:HEARTLAND MEDICAL SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LARISA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHARCHENKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-298-5518
Mailing Address - Street 1:13811 114TH AVE N
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:MN
Mailing Address - Zip Code:55369
Mailing Address - Country:US
Mailing Address - Phone:612-298-5518
Mailing Address - Fax:263-425-7671
Practice Address - Street 1:13811 114TH AVE N
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:MN
Practice Address - Zip Code:55369
Practice Address - Country:US
Practice Address - Phone:612-298-5518
Practice Address - Fax:763-425-7671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-12
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies