MEDICARE: HEARTLAND VASCULAR CARE PLLC

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	2085R0204X	Vascular & Interventional Radiology Physician

General Provider Information

NPI Number	:	1134804420
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEARTLAND VASCULAR CARE PLLC

Provider Business Mailing Address
First Line	:	3001 PALM HARBOR BLVD STE A
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34683-1930
Country	:	US
Telephone Number	:	727-474-0090
Fax Number	:	727-474-0055

Provider Business Practice Location Address
First Line	:	2420 W NEBRASKA AVE
Second Line	:
City	:	PEORIA
State	:	IL
Zip	:	61604-3112
Country	:	US
Telephone Number	:	309-680-5000
Fax Number	:

Authorized Official
Title or Position	:	CHIEF OPERATIONS OFFICER
Name	:	KEVIN GARDNER
Credential	:
Telephone Number	:	309-680-5000

Provider Enumeration Date	:	06/15/2023
Last Update Date	:	06/15/2023

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Directions to “HEARTLAND VASCULAR CARE PLLC ” Practice Location

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