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General NPI Number Information
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NPI Number | 1689740458
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Entity Type | Organization
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Legal Business Name | HEARTLAND PEDIATRICS P.C.
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Dates
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Enumeration Date | 11/25/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 201 RIDGE ST SUITE 314
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City | COUNCIL BLUFFS
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State | IA
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Zip | 51503-4643
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Country | US
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Telephone | 712-396-5437
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Fax | 712-396-5440
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Provider Business Mailing Address
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Address Line | 201 RIDGE ST SUITE 314
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City | COUNCIL BLUFFS
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State | IA
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Zip | 51503-4643
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Country | US
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Telephone | 712-396-5437
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Fax | 712-396-5440
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SCOTT BOMGAARS
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Credential | M.D.
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Telephone | 712-396-5437
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State | NE
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