Healthcare Provider Details

I. General information

NPI: 1457494155
Provider Name (Legal Business Name): HEARTLAND MEDICAL SUPPLY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 04/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 US 27 S
LAKE PLACID FL
33852-7900
US

IV. Provider business mailing address

6360 US HIGHWAY 27 N
SEBRING FL
33870-1225
US

V. Phone/Fax

Practice location:
  • Phone: 863-465-0024
  • Fax: 863-465-9656
Mailing address:
  • Phone: 863-386-0081
  • Fax: 863-385-5118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberPH15581
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License NumberPH15581
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License NumberPH15581
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberPH15581
License Number StateFL

VIII. Authorized Official

Name: ROBERT E. DUNCAN
Title or Position: PRESIDENT
Credential: R.PH.
Phone: 863-385-7673