Provider Demographics
NPI:1013695139
Name:HEARTLAND PITTSBURG DIALYSIS LLC
Entity type:Organization
Organization Name:HEARTLAND PITTSBURG DIALYSIS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-676-0174
Mailing Address - Street 1:2828 S GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:MO
Mailing Address - Zip Code:64836
Mailing Address - Country:US
Mailing Address - Phone:417-358-5500
Mailing Address - Fax:417-358-5510
Practice Address - Street 1:2425 S ROUSE ST
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:KS
Practice Address - Zip Code:66762-6606
Practice Address - Country:US
Practice Address - Phone:620-231-0656
Practice Address - Fax:620-231-1901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-10
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment