Provider Demographics
NPI:1578647772
Name:HEARTLAND EMERGICARE
Entity Type:Organization
Organization Name:HEARTLAND EMERGICARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:E
Authorized Official - Last Name:KERSHNER
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:402-330-7403
Mailing Address - Street 1:TOTAL HEALTHCARE
Mailing Address - Street 2:14610 W CENTER RD
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144
Mailing Address - Country:US
Mailing Address - Phone:402-731-7333
Mailing Address - Fax:402-614-5405
Practice Address - Street 1:HEARTLAND EMERGICARE
Practice Address - Street 2:2429 M STR
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68107
Practice Address - Country:US
Practice Address - Phone:402-731-7333
Practice Address - Fax:402-614-5405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2009-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========03Medicaid