Provider Demographics
NPI:1962645861
Name:HEARTLAND CARDIOLOGYPC
Entity Type:Organization
Organization Name:HEARTLAND CARDIOLOGYPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CLARENCE
Authorized Official - Middle Name:B
Authorized Official - Last Name:AMAYUN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:765-453-8001
Mailing Address - Street 1:3611 S REED RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46902-3828
Mailing Address - Country:US
Mailing Address - Phone:765-453-8001
Mailing Address - Fax:765-453-8002
Practice Address - Street 1:3611 S REED RD
Practice Address - Street 2:SUITE 106
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-3828
Practice Address - Country:US
Practice Address - Phone:765-453-8001
Practice Address - Fax:765-453-8002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-08
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01041643261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN260540Medicare PIN