Provider Demographics
NPI:1558303164
Name:HEARTLANDS RADIATION THERAPY PC
Entity Type:Organization
Organization Name:HEARTLANDS RADIATION THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:S
Authorized Official - Last Name:PIECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-727-3580
Mailing Address - Street 1:PO BOX 485
Mailing Address - Street 2:
Mailing Address - City:BOYS TOWN
Mailing Address - State:NE
Mailing Address - Zip Code:68010-0485
Mailing Address - Country:US
Mailing Address - Phone:402-727-3580
Mailing Address - Fax:
Practice Address - Street 1:450 E 23RD ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-2303
Practice Address - Country:US
Practice Address - Phone:402-727-3580
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10024966800Medicaid
DG8502OtherMEDICARE RR
DG8502OtherMEDICARE RR
NE10024966800Medicaid