Provider Demographics
NPI:1952458697
Name:HEARTLAND NEUROLOGY PC
Entity Type:Organization
Organization Name:HEARTLAND NEUROLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:T
Authorized Official - Last Name:OHR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:712-328-5350
Mailing Address - Street 1:800 MERCY DR
Mailing Address - Street 2:STE 110
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-3128
Mailing Address - Country:US
Mailing Address - Phone:712-328-5350
Mailing Address - Fax:712-328-5354
Practice Address - Street 1:800 MERCY DR
Practice Address - Street 2:STE 110
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-3128
Practice Address - Country:US
Practice Address - Phone:712-328-5350
Practice Address - Fax:712-328-5354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA26933174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2274787Medicaid
IA2274787Medicaid
IA27478Medicare ID - Type Unspecified