Provider Demographics
NPI:1396967774
Name:HEARTLAND SOFTWARE SERVICES, INC
Entity type:Organization
Organization Name:HEARTLAND SOFTWARE SERVICES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WADE
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:WICKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-740-0650
Mailing Address - Street 1:P.O. BOX 390442
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68139
Mailing Address - Country:US
Mailing Address - Phone:402-740-0650
Mailing Address - Fax:402-884-6637
Practice Address - Street 1:9905 SOUTH 176TH STREET
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68136
Practice Address - Country:US
Practice Address - Phone:402-740-0650
Practice Address - Fax:402-884-6637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0437798Medicaid