Provider Demographics
NPI:1689367252
Name:HEARTLAND MEDICAL CLINIC, INC
Entity Type:Organization
Organization Name:HEARTLAND MEDICAL CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:MEREDITH
Authorized Official - Last Name:BRANSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-841-7297
Mailing Address - Street 1:1312 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044-2219
Mailing Address - Country:US
Mailing Address - Phone:785-841-7297
Mailing Address - Fax:855-634-9302
Practice Address - Street 1:534 MICHIGAN STREET
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044
Practice Address - Country:US
Practice Address - Phone:785-841-7297
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-31
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty