Provider Demographics
NPI:1356564991
Name:HEARTLAND ORTHOPAEDIC AND SPORTS MEDICINE CLINIC LLC
Entity type:Organization
Organization Name:HEARTLAND ORTHOPAEDIC AND SPORTS MEDICINE CLINIC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:W
Authorized Official - Last Name:FISCHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-721-0090
Mailing Address - Street 1:2740 N CLARKSON ST STE 100
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68025-7716
Mailing Address - Country:US
Mailing Address - Phone:402-721-0090
Mailing Address - Fax:402-721-9661
Practice Address - Street 1:2740 N CLARKSON SUITE 100
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-7716
Practice Address - Country:US
Practice Address - Phone:402-721-0090
Practice Address - Fax:402-721-9661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE15374207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========13Medicaid
251492Medicare PIN
281053Medicare PIN
NE1301640001Medicare NSC
NE271791Medicare ID - Type UnspecifiedMEDICARE #
251492Medicare PIN
281053Medicare PIN