MEDICARE: HEARTLAND PAIN MANAGEMENT , 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	207LP2900X	Pain Medicine (Anesthesiology) Physician

General Provider Information

NPI Number	:	1972574937
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEARTLAND PAIN MANAGEMENT , LLC

Provider Business Mailing Address
First Line	:	1133 COLLEGE AVE STE F100
Second Line	:
City	:	MANHATTAN
State	:	KS
Zip	:	66502-2756
Country	:	US
Telephone Number	:	785-320-6700
Fax Number	:	785-320-6701

Provider Business Practice Location Address
First Line	:	1133 COLLEGE AVE STE F100
Second Line	:
City	:	MANHATTAN
State	:	KS
Zip	:	66502-2756
Country	:	US
Telephone Number	:	785-320-6700
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN OWNER
Name	:	STEVEN ROBERT PELOQUIN
Credential	:	MD
Telephone Number	:	785-320-6700

Provider Enumeration Date	:	01/30/2006
Last Update Date	:	04/11/2018

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