MEDICARE: HEARTLAND CONSUMER DIRECTED SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	302R00000X	Health Maintenance Organization	LC1236901	MO

General Provider Information

NPI Number	:	1033462460
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEARTLAND CONSUMER DIRECTED SERVICES

Provider Business Mailing Address
First Line	:	8420 OLIVE BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63132-2816
Country	:	US
Telephone Number	:	314-395-9758
Fax Number	:

Provider Business Practice Location Address
First Line	:	8420 OLIVE BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63132-2816
Country	:	US
Telephone Number	:	314-395-9758
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	JUNE WALKER
Credential	:
Telephone Number	:	314-395-9758

Provider Enumeration Date	:	10/23/2012
Last Update Date	:	10/23/2012

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Directions to “HEARTLAND CONSUMER DIRECTED SERVICES ” Practice Location

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