Provider Demographics
NPI:1144478330
Name:HEARTLAND SPINE, LLC
Entity type:Organization
Organization Name:HEARTLAND SPINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FRANKLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYWARD
Authorized Official - Suffix:II
Authorized Official - Credentials:DO
Authorized Official - Phone:573-331-5761
Mailing Address - Street 1:3250 GORDONVILLE RD
Mailing Address - Street 2:SUITE 450
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63703-5056
Mailing Address - Country:US
Mailing Address - Phone:573-331-5761
Mailing Address - Fax:573-331-5762
Practice Address - Street 1:3905 W ERNESTINE DR
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-5800
Practice Address - Country:US
Practice Address - Phone:573-331-5761
Practice Address - Fax:573-331-5762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006012799207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty