MEDICARE: HEARTLAND RADIOLOGY, INC.

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	2085R0202X	Diagnostic Radiology Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	DO3729	OTHER	MO	RAILROAD MEDICARE
8	CH4567	OTHER	MO	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	222143	OTHER		HEALTHLINK INC.
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	130569	OTHER	MO	BCBS
6	1600702	OTHER		UNITED HEALTHCARE
7	655009	OTHER		FIRST HEALTH

General Provider Information

NPI Number	:	1326025412
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEARTLAND RADIOLOGY, INC.

Provider Business Mailing Address
First Line	:	PO BOX 459
Second Line	:
City	:	POPLAR BLUFF
State	:	MO
Zip	:	63902-0459
Country	:	US
Telephone Number	:	573-222-7441
Fax Number	:	573-222-7441

Provider Business Practice Location Address
First Line	:	221 PHYSICIANS PARK
Second Line	:
City	:	POPLAR BLUFF
State	:	MO
Zip	:	63901-3956
Country	:	US
Telephone Number	:	573-727-9080
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DONNA L. ALMOND
Credential	:
Telephone Number	:	573-222-7441

Provider Enumeration Date	:	12/29/2005
Last Update Date	:	09/09/2009

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Directions to “HEARTLAND RADIOLOGY, INC. ” Practice Location

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