Healthcare Provider Details

I. General information

NPI: 1356849616
Provider Name (Legal Business Name): HEARTLAND WOMEN'S HEALTHCARE MO PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2018
Last Update Date: 01/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2340 KATY LN
POPLAR BLUFF MO
63901-2300
US

IV. Provider business mailing address

1407 MCPHERSON AVE
MOUNT VERNON IL
62864-2822
US

V. Phone/Fax

Practice location:
  • Phone: 618-997-5266
  • Fax: 618-997-5285
Mailing address:
  • Phone: 618-997-5266
  • Fax: 618-997-5285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL SCHIFANO
Title or Position: PRESIDENT
Credential: DO
Phone: 618-997-5266