Provider Demographics
NPI:1831419449
Name:HEARTLAND NATURAL HEALTH LLC
Entity type:Organization
Organization Name:HEARTLAND NATURAL HEALTH LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:KEETH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:816-804-7115
Mailing Address - Street 1:2828 NW 50TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-8004
Mailing Address - Country:US
Mailing Address - Phone:405-445-6126
Mailing Address - Fax:877-866-2141
Practice Address - Street 1:2828 NW 50TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-8004
Practice Address - Country:US
Practice Address - Phone:405-445-6126
Practice Address - Fax:877-866-2141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-04
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4038261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center