Healthcare Provider Details

I. General information

NPI: 1144325515
Provider Name (Legal Business Name): HEARTLAND PULMONARY REHAB & OXYGEN SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 PORTLAND ST
COLUMBIA MO
65201-6569
US

IV. Provider business mailing address

2609 CHAPEL WOOD TER
COLUMBIA MO
65203-5714
US

V. Phone/Fax

Practice location:
  • Phone: 573-999-7710
  • Fax: 573-445-8011
Mailing address:
  • Phone: 573-445-8011
  • Fax: 573-445-8011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: TIM HOGAN
Title or Position: PRESIDENT
Credential:
Phone: 573-999-7710