MEDICARE: HEARTLAND DIAGNOSTIC SERVICES LLC

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	2471C3402X	Radiography Radiologic Technologist
2	291U00000X	Clinical Medical Laboratory

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	024761	OTHER	ND	ND BLUE SHIELD
2	600R3HE	OTHER	MN	MN BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	600R4HE	OTHER	MN	MN BLUE SHIELD

General Provider Information

NPI Number	:	1861432361
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEARTLAND DIAGNOSTIC SERVICES LLC

Provider Business Mailing Address
First Line	:	3290 20TH ST S
Second Line	:
City	:	FARGO
State	:	ND
Zip	:	58104-5917
Country	:	US
Telephone Number	:	701-499-4800
Fax Number	:	701-499-4887

Provider Business Practice Location Address
First Line	:	3290 20TH ST S
Second Line	:
City	:	FARGO
State	:	ND
Zip	:	58104-5917
Country	:	US
Telephone Number	:	701-499-4800
Fax Number	:	701-499-4887

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	MARGARET S GILBERTSON
Credential	:
Telephone Number	:	701-499-4807

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	04/02/2013

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Directions to “HEARTLAND DIAGNOSTIC SERVICES LLC ” Practice Location

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