Provider Demographics
NPI:1811026461
Name:HEARTLAND RESOURCES, INC.
Entity Type:Organization
Organization Name:HEARTLAND RESOURCES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:VIRGIE
Authorized Official - Middle Name:TRAVELLE
Authorized Official - Last Name:WHITAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-209-3600
Mailing Address - Street 1:108 EAST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:EWING
Mailing Address - State:MO
Mailing Address - Zip Code:63440-0460
Mailing Address - Country:US
Mailing Address - Phone:573-209-3600
Mailing Address - Fax:573-209-3509
Practice Address - Street 1:108 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:EWING
Practice Address - State:MO
Practice Address - Zip Code:63440-0460
Practice Address - Country:US
Practice Address - Phone:573-209-3600
Practice Address - Fax:573-209-3509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service