Healthcare Provider Details

I. General information

NPI: 1679536478
Provider Name (Legal Business Name): HEARTLAND HOME MEDICAL SUPPLY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 03/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

716 E EMPIRE ST STE 2
BLOOMINGTON IL
61701-8613
US

IV. Provider business mailing address

716 E EMPIRE ST STE 2
BLOOMINGTON IL
61701-8613
US

V. Phone/Fax

Practice location:
  • Phone: 309-829-8122
  • Fax: 309-829-8899
Mailing address:
  • Phone: 309-829-8122
  • Fax: 309-829-8899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: CATHERINE ROUSEY
Title or Position: CO-OWNER
Credential:
Phone: 309-829-8122