MEDICARE: HEARTLAND HEALTH CENTER, 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	261QF0400X	Federally Qualified Health Center (FQHC)	HC069	NE
2	1223G0001X	General Practice Dentistry	HC069	NE

General Provider Information

NPI Number	:	1326418641
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEARTLAND HEALTH CENTER, INC

Provider Business Mailing Address
First Line	:	3307 W CAPITAL AVE
Second Line	:
City	:	GRAND ISLAND
State	:	NE
Zip	:	68803-1334
Country	:	US
Telephone Number	:	308-382-4297
Fax Number	:	308-382-4376

Provider Business Practice Location Address
First Line	:	3327 W CAPITAL AVE
Second Line	:
City	:	GRAND ISLAND
State	:	NE
Zip	:	68803-1334
Country	:	US
Telephone Number	:	308-382-4297
Fax Number	:	308-382-4376

Authorized Official
Title or Position	:	FINANCIAL DIRECTOR
Name	:	KARI WILCOX
Credential	:
Telephone Number	:	308-382-4297

Provider Enumeration Date	:	09/29/2015
Last Update Date	:	08/15/2016

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