Healthcare Provider Details

I. General information

NPI: 1629065560
Provider Name (Legal Business Name): HEARTLAND MEDICAL AND HOME HEALTH EQUIPMENT,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 10/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 ACCESS RD
ELK CITY OK
73644-2929
US

IV. Provider business mailing address

PO BOX 445
ELK CITY OK
73648-0445
US

V. Phone/Fax

Practice location:
  • Phone: 580-243-5551
  • Fax: 580-243-5552
Mailing address:
  • Phone: 580-243-5551
  • Fax: 580-243-5552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MRS. STEFANIE EDNEY
Title or Position: OWNER
Credential:
Phone: 580-243-5551