Healthcare Provider Details

I. General information

NPI: 1184289803
Provider Name (Legal Business Name): HEARTLAND HEMATOLOGY & ONCOLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2019
Last Update Date: 05/08/2019
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 Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JUDY MAIN
Title or Position: OFFICE ADMINISTRATOR
Credential:
Phone: 308-865-2303