Provider Demographics
NPI:1558443002
Name:HEARTLAND HEARING CENTER
Entity Type:Organization
Organization Name:HEARTLAND HEARING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:FREY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-932-1999
Mailing Address - Street 1:7710 MERCY RD
Mailing Address - Street 2:BERGAN PROFESSIONAL CENTER NORTH, SUITE 322
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-2372
Mailing Address - Country:US
Mailing Address - Phone:402-932-1999
Mailing Address - Fax:402-932-1948
Practice Address - Street 1:7710 MERCY RD
Practice Address - Street 2:BERGAN PROFESSIONAL CENTER NORTH, SUITE 322
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-2372
Practice Address - Country:US
Practice Address - Phone:402-932-1999
Practice Address - Fax:402-932-1948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE21783237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025185000Medicaid
NE10025185000Medicaid