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General NPI Number Information
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NPI Number | 1306935713
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Entity Type | Organization
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Legal Business Name | HEARTLAND LABORATORIES, INC.
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Dates
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Enumeration Date | 10/12/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 520 S PIERCE AVE SUITE 206
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City | MASON CITY
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State | IA
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Zip | 50401-2749
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Country | US
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Telephone | 641-423-3140
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Fax |
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Provider Business Mailing Address
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Address Line | 520 S PIERCE AVE SUITE 206
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City | MASON CITY
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State | IA
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Zip | 50401-2749
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Country | US
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Telephone | 641-423-3140
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. TOM LEISURE
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Credential |
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Telephone | 641-512-6118
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | ABCCPO1669
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License Number State | IA
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