Healthcare Provider Details

I. General information

NPI: 1033386859
Provider Name (Legal Business Name): HEARTLAND DIAGNOSTIC SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2008
Last Update Date: 06/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3280 20TH ST S
FARGO ND
58104-5917
US

IV. Provider business mailing address

3280 20TH ST S
FARGO ND
58104-5917
US

V. Phone/Fax

Practice location:
  • Phone: 701-499-4807
  • Fax: 701-293-7408
Mailing address:
  • Phone: 701-499-4807
  • Fax: 701-293-7408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License Number
License Number State

VIII. Authorized Official

Name: HOADLEY H HARRIS
Title or Position: DIRECTOR
Credential: M.D.
Phone: 701-499-4807