Healthcare Provider Details

I. General information

NPI: 1447280474
Provider Name (Legal Business Name): HEARTLAND PATHOLOGY CONSULTANTS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 12/08/2021
Certification Date: 12/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 COLTRANE PL STE 3
EDMOND OK
73034-6783
US

IV. Provider business mailing address

PO BOX 26343
OKLAHOMA CITY OK
73126-0343
US

V. Phone/Fax

Practice location:
  • Phone: 405-715-4500
  • Fax: 405-715-4519
Mailing address:
  • Phone: 405-705-0018
  • Fax: 405-705-0029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number
License Number State

VIII. Authorized Official

Name: ROSIE J CHEADLE
Title or Position: BILLING SUPERVISOR
Credential:
Phone: 405-705-2644