Healthcare Provider Details

I. General information

NPI: 1073685061
Provider Name (Legal Business Name): HEARTLAND CARDIAC AND VASCULAR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1051 W FROMDAHL DR
ROSEBURG OR
97470-2714
US

IV. Provider business mailing address

1051 W FROMDAHL DR
ROSEBURG OR
97470-2714
US

V. Phone/Fax

Practice location:
  • Phone: 541-672-5995
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberR0000ZGBFM
License Number StateMT

VIII. Authorized Official

Name: MARJORIE FELDMAN
Title or Position: SECRETARY
Credential:
Phone: 541-672-5995