Healthcare Provider Details

I. General information

NPI: 1205885712
Provider Name (Legal Business Name): HEARTLAND EMS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N2930 STATE ROAD 22
WAUTOMA WI
54982-5267
US

IV. Provider business mailing address

367 CEDAR CROSS RD
DUBUQUE IA
52003-7730
US

V. Phone/Fax

Practice location:
  • Phone: 920-787-2291
  • Fax: 920-787-4033
Mailing address:
  • Phone: 563-582-7661
  • Fax: 920-787-4033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number2310300
License Number StateIA

VIII. Authorized Official

Name: MR. CHUCK USKAVITCH
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 563-582-7661