MEDICARE: HEARTLAND SLEEP AND PULMONARY LAB LLC

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	291U00000X	Clinical Medical Laboratory	HCC6339	FL

General Provider Information

NPI Number	:	1770533721
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEARTLAND SLEEP AND PULMONARY LAB LLC

Provider Business Mailing Address
First Line	:	1751 US HIGHWAY 27 S
Second Line	:
City	:	SEBRING
State	:	FL
Zip	:	33870-4920
Country	:	US
Telephone Number	:	863-386-1599
Fax Number	:	863-386-1699

Provider Business Practice Location Address
First Line	:	1751 US HIGHWAY 27 S
Second Line	:
City	:	SEBRING
State	:	FL
Zip	:	33870-4920
Country	:	US
Telephone Number	:	863-386-1599
Fax Number	:	863-386-1699

Authorized Official
Title or Position	:	OWNER
Name	:	MARK E LUCKENBACH
Credential	:	CRT
Telephone Number	:	863-386-1599

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	03/05/2008

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