Healthcare Provider Details

I. General information

NPI: 1609895713
Provider Name (Legal Business Name): HEARTLAND HEMATOLOGY & ONCOLOGY P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 01/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 W 42ND ST
KEARNEY NE
68845-2401
US

IV. Provider business mailing address

412 W 42ND ST
KEARNEY NE
68845-2401
US

V. Phone/Fax

Practice location:
  • Phone: 308-865-2303
  • Fax: 308-865-2304
Mailing address:
  • Phone: 308-865-2303
  • Fax: 308-865-2304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number18931
License Number StateNE

VIII. Authorized Official

Name: JUDY A MAIN
Title or Position: RN/OFFICE MANAGER
Credential: RN/BSN
Phone: 308-865-2303