Provider Demographics
NPI:1689740458
Name:HEARTLAND PEDIATRICS P.C.
Entity Type:Organization
Organization Name:HEARTLAND PEDIATRICS P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:BOMGAARS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:712-396-5437
Mailing Address - Street 1:201 RIDGE ST
Mailing Address - Street 2:SUITE 314
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-4643
Mailing Address - Country:US
Mailing Address - Phone:712-396-5437
Mailing Address - Fax:712-396-5440
Practice Address - Street 1:201 RIDGE ST
Practice Address - Street 2:SUITE 314
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-4643
Practice Address - Country:US
Practice Address - Phone:712-396-5437
Practice Address - Fax:712-396-5440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty