Provider Demographics
NPI:1659529311
Name:HEARTLAND FOOT & ANKLE ASSOCIATES PC
Entity Type:Organization
Organization Name:HEARTLAND FOOT & ANKLE ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:JOMARIE
Authorized Official - Last Name:LOCKWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:309-661-9975
Mailing Address - Street 1:10 HEARTLAND DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61704-7741
Mailing Address - Country:US
Mailing Address - Phone:309-661-9975
Mailing Address - Fax:309-661-9920
Practice Address - Street 1:10 HEARTLAND DR
Practice Address - Street 2:SUITE B
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61704-7775
Practice Address - Country:US
Practice Address - Phone:309-661-9975
Practice Address - Fax:309-661-9920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-05
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016.005357213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0732240001OtherDMERC # WITH PPG
IL016005357Medicaid
560750002Medicare PIN
6235380001Medicare NSC
0732240001OtherDMERC # WITH PPG