Provider Demographics
NPI:1679536478
Name:HEARTLAND HOME MEDICAL SUPPLY, INC.
Entity Type:Organization
Organization Name:HEARTLAND HOME MEDICAL SUPPLY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROUSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-829-8122
Mailing Address - Street 1:716 E EMPIRE ST
Mailing Address - Street 2:STE 2
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61701-8613
Mailing Address - Country:US
Mailing Address - Phone:309-829-8122
Mailing Address - Fax:309-829-8899
Practice Address - Street 1:716 E EMPIRE ST
Practice Address - Street 2:STE 2
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701-8613
Practice Address - Country:US
Practice Address - Phone:309-829-8122
Practice Address - Fax:309-829-8899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-11
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL101025OtherHEALTH ALLIANCE
IL05732076OtherBCBS
IL=========001Medicaid
IL05732076OtherBCBS