Provider Demographics
NPI:1780763078
Name:HEARTLAND ENT & ALLERGY CENTER, P.S.C.
Entity type:Organization
Organization Name:HEARTLAND ENT & ALLERGY CENTER, P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIRO
Authorized Official - Middle Name:J
Authorized Official - Last Name:YUN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-765-5127
Mailing Address - Street 1:101 FINANCIAL DRIVE, SUITE 104
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-8450
Mailing Address - Country:US
Mailing Address - Phone:270-765-5127
Mailing Address - Fax:270-765-5337
Practice Address - Street 1:101 FINANCIAL DRIVE, SUITE 104
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-8450
Practice Address - Country:US
Practice Address - Phone:270-765-5127
Practice Address - Fax:270-765-5337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65920233Medicaid
4539Medicare ID - Type Unspecified