Healthcare Provider Details

I. General information

NPI: 1295890176
Provider Name (Legal Business Name): HEARTLAND CENTER FOR REPRODUCTIVE MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7308 S 142ND ST
OMAHA NE
68138-6804
US

IV. Provider business mailing address

7308 S 142ND ST
OMAHA NE
68138-6804
US

V. Phone/Fax

Practice location:
  • Phone: 402-717-4200
  • Fax: 402-717-4231
Mailing address:
  • Phone: 402-717-4200
  • Fax: 402-717-4231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberASC031
License Number StateNE

VIII. Authorized Official

Name: DEETTE STAEBELL
Title or Position: ADMINISTRATOR
Credential:
Phone: 402-717-4200