Provider Demographics
NPI:1578714721
Name:HEARTLAND PATHOLOGY CONSULTANTS, PCS
Entity Type:Organization
Organization Name:HEARTLAND PATHOLOGY CONSULTANTS, PCS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ROSIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:CHEADLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-705-0018
Mailing Address - Street 1:PO BOX 26343
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73126-0343
Mailing Address - Country:US
Mailing Address - Phone:405-705-0018
Mailing Address - Fax:405-705-0029
Practice Address - Street 1:3509 FRENCH PARK DR
Practice Address - Street 2:SUITE D
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-7296
Practice Address - Country:US
Practice Address - Phone:405-705-0018
Practice Address - Fax:405-705-0029
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEARTLAND PATHOLOGY CONSULTANTS, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-07
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK16447208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100746640AMedicaid
OK=========Medicare PIN