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NPI Code Detail

MEDICARE: HEARTLAND DIAGNOSTIC IMAGING

MEDICARE: HEARTLAND DIAGNOSTIC IMAGING
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
12085R0202XDiagnostic Radiology PhysicianIN

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2DA4142OTHERINRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000000315548OTHERINBC BS

General Provider Information

NPI Number : 1568460830
Entity Type Code : Organization
Provider Name (Legal Business Name) : HEARTLAND DIAGNOSTIC IMAGING
Provider Business Mailing Address
First Line : PO BOX 753
Second Line :
City : GOSHEN
State : IN
Zip : 46527-0753
Country : US
Telephone Number : 937-323-5400
Fax Number :
Provider Business Practice Location Address
First Line : 200 HIGH PARK AVE
Second Line :
City : GOSHEN
State : IN
Zip : 46526-4810
Country : US
Telephone Number : 574-533-2141
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : EUGENE LONG
Credential : MD
Telephone Number : 574-533-2141
Provider Enumeration Date : 07/12/2005
Last Update Date : 07/21/2022

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Directions to “HEARTLAND DIAGNOSTIC IMAGING ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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