Healthcare Provider Details

I. General information

NPI: 1033135595
Provider Name (Legal Business Name): HEARTLAND EMERGICARE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 02/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2429 M STREET
OMAHA NE
68107
US

IV. Provider business mailing address

14610 W CENTER RD
OMAHA NE
68144
US

V. Phone/Fax

Practice location:
  • Phone: 402-731-7333
  • Fax: 402-614-5405
Mailing address:
  • Phone: 402-330-7403
  • Fax: 402-330-7246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number710
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID E KERSHNER
Title or Position: PRESIDENT CEO
Credential:
Phone: 402-330-7403