MEDICARE: HEARTLAND RADIOLOGY ASSOCIATES LTD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician		IL

General Provider Information

NPI Number	:	1629049952
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEARTLAND RADIOLOGY ASSOCIATES LTD

Provider Business Mailing Address
First Line	:	4227 LINCOLNSHIRE DRIVE
Second Line	:
City	:	MOUNT VERNON
State	:	IL
Zip	:	62864-2157
Country	:	US
Telephone Number	:	618-242-2317
Fax Number	:	618-242-9710

Provider Business Practice Location Address
First Line	:	4227 LINCOLNSHIRE DRIVE
Second Line	:
City	:	MOUNT VERNON
State	:	IL
Zip	:	62864-2157
Country	:	US
Telephone Number	:	618-242-2317
Fax Number	:	618-242-9710

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JACQUELINE A TRESCHUK-BAHN
Credential	:	MD
Telephone Number	:	618-242-2317

Provider Enumeration Date	:	01/26/2006
Last Update Date	:	08/22/2020

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