Provider Demographics
NPI:1811034887
Name:HEARTLAND RADIOLOGY, PA
Entity Type:Organization
Organization Name:HEARTLAND RADIOLOGY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KHALED
Authorized Official - Middle Name:
Authorized Official - Last Name:TOUMEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:316-685-6091
Mailing Address - Street 1:9313 E 34TH ST N
Mailing Address - Street 2:STE 100
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-2637
Mailing Address - Country:US
Mailing Address - Phone:316-685-6091
Mailing Address - Fax:
Practice Address - Street 1:1124 W 21ST
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:KS
Practice Address - Zip Code:67002
Practice Address - Country:US
Practice Address - Phone:316-300-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS111299OtherBCBS
111299Medicare PIN