Provider Demographics
NPI:1205885712
Name:HEARTLAND EMS, INC.
Entity type:Organization
Organization Name:HEARTLAND EMS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHUCK
Authorized Official - Middle Name:
Authorized Official - Last Name:USKAVITCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-582-7661
Mailing Address - Street 1:367 CEDAR CROSS RD
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52003-7730
Mailing Address - Country:US
Mailing Address - Phone:563-582-7661
Mailing Address - Fax:920-787-4033
Practice Address - Street 1:N2930 STATE ROAD 22
Practice Address - Street 2:
Practice Address - City:WAUTOMA
Practice Address - State:WI
Practice Address - Zip Code:54982-5267
Practice Address - Country:US
Practice Address - Phone:920-787-2291
Practice Address - Fax:920-787-4033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA23103003416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0416172Medicaid
WI80455200Medicaid
WI80455200Medicaid
IAP00083100Medicare ID - Type UnspecifiedRAILROAD MEDICARE
WI80455200Medicaid