Provider Demographics
NPI:1558631671
Name:HEARTLAND OSTEOPATHIC MEDICINE
Entity Type:Organization
Organization Name:HEARTLAND OSTEOPATHIC MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CLAYTON
Authorized Official - Middle Name:
Authorized Official - Last Name:HOBERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:402-599-9231
Mailing Address - Street 1:2501 S 102ND ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-1805
Mailing Address - Country:US
Mailing Address - Phone:402-599-9231
Mailing Address - Fax:
Practice Address - Street 1:2501 S 102ND ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-1805
Practice Address - Country:US
Practice Address - Phone:402-599-9231
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-05
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE687208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty