MEDICARE: HEARTLAND MEDICAL ASSOCIATES, 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	207R00000X	Internal Medicine Physician	2004014268
2	207RC0000X	Cardiovascular Disease Physician	101538	MO
3	363L00000X	Nurse Practitioner	084895
4	207RG0100X	Gastroenterology Physician	101572	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790810513
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEARTLAND MEDICAL ASSOCIATES, LLC

Provider Business Mailing Address
First Line	:	1527 UNION AVE
Second Line	:
City	:	MOBERLY
State	:	MO
Zip	:	65270-9407
Country	:	US
Telephone Number	:	660-372-8008
Fax Number	:	660-372-8010

Provider Business Practice Location Address
First Line	:	1527 UNION AVE
Second Line	:
City	:	MOBERLY
State	:	MO
Zip	:	65270-9407
Country	:	US
Telephone Number	:	660-372-8008
Fax Number	:	660-372-8010

Authorized Official
Title or Position	:	MD
Name	:	AMEENA ANEES
Credential	:
Telephone Number	:	660-372-8008

Provider Enumeration Date	:	02/22/2007
Last Update Date	:	10/03/2019

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