Provider Demographics
NPI:1013462662
Name:HEARTLAND MEDICAL CLINIC, INC.
Entity Type:Organization
Organization Name:HEARTLAND MEDICAL CLINIC, INC.
Other - Org Name:HEARTLAND COMMUNITY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBYN
Authorized Official - Middle Name:
Authorized Official - Last Name:COVENTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-841-7297
Mailing Address - Street 1:346 MAINE ST
Mailing Address - Street 2:SUITE 150
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044-1393
Mailing Address - Country:US
Mailing Address - Phone:785-841-7297
Mailing Address - Fax:785-856-0375
Practice Address - Street 1:100 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:OSKALOOSA
Practice Address - State:KS
Practice Address - Zip Code:66066-4168
Practice Address - Country:US
Practice Address - Phone:785-841-7297
Practice Address - Fax:785-856-0375
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEARTLAND MEDICAL CLINIC, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-08-23
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0528427207Q00000X
KS04-33272208000000X
261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)Group - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200688980AMedicaid
KSE08867Medicare UPIN
KS200688980AMedicaid