Provider Demographics
NPI:1629104518
Name:HEARTLAND PLASTIC AND RECONSTRUCTIVE SURGERY P.C.
Entity Type:Organization
Organization Name:HEARTLAND PLASTIC AND RECONSTRUCTIVE SURGERY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:J
Authorized Official - Last Name:CHERNY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:515-254-2265
Mailing Address - Street 1:10611 HICKMAN RD
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50322-3731
Mailing Address - Country:US
Mailing Address - Phone:515-254-2265
Mailing Address - Fax:515-254-2272
Practice Address - Street 1:10611 HICKMAN RD
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50322-3731
Practice Address - Country:US
Practice Address - Phone:515-254-2265
Practice Address - Fax:515-254-2272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA26965174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0423319Medicaid
IA0423319Medicaid