Healthcare Provider Details

I. General information

NPI: 1942476577
Provider Name (Legal Business Name): HEARTLAND MEDICAL SUPPLIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2008
Last Update Date: 05/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 RAILROAD CIR
BONNIEVILLE KY
42713-8467
US

IV. Provider business mailing address

41 RAILROAD CIR
BONNIEVILLE KY
42713-8467
US

V. Phone/Fax

Practice location:
  • Phone: 270-531-6565
  • Fax:
Mailing address:
  • Phone: 270-531-6565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number StateKY

VIII. Authorized Official

Name: MR. DENIS OWEN EDWARDS I
Title or Position: OWNER
Credential:
Phone: 270-531-6565