Provider Demographics
NPI:1528215332
Name:HEARTLAND SPINE, LLC
Entity Type:Organization
Organization Name:HEARTLAND SPINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FRANKLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYWARD
Authorized Official - Suffix:II
Authorized Official - Credentials:DO
Authorized Official - Phone:573-837-9989
Mailing Address - Street 1:3250 GORDONVILLE RD
Mailing Address - Street 2:SUITE 450
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63703-5056
Mailing Address - Country:US
Mailing Address - Phone:573-837-9989
Mailing Address - Fax:
Practice Address - Street 1:3250 GORDONVILLE RD
Practice Address - Street 2:SUITE 450
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-5056
Practice Address - Country:US
Practice Address - Phone:573-837-9989
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-22
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006012799207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO6219020001Medicare NSC