Provider Demographics
NPI:1548494743
Name:HEARTLAND LABORATORIES INC
Entity type:Organization
Organization Name:HEARTLAND LABORATORIES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:S
Authorized Official - Last Name:LEISURE
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:641-423-3410
Mailing Address - Street 1:520 S PIERCE AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-2749
Mailing Address - Country:US
Mailing Address - Phone:641-423-3410
Mailing Address - Fax:641-423-5264
Practice Address - Street 1:4025 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50701-5639
Practice Address - Country:US
Practice Address - Phone:641-423-3410
Practice Address - Fax:641-423-5264
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEARTLAND LABORATORIES INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-05-04
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAABCCPO1669335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier