Provider Demographics
NPI:1184787343
Name:HEARTLAND VASCULAR MEDICINE AND SURGERY PC
Entity type:Organization
Organization Name:HEARTLAND VASCULAR MEDICINE AND SURGERY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:RUSSELL
Authorized Official - Last Name:KOSLOW
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FACS
Authorized Official - Phone:515-284-1976
Mailing Address - Street 1:974 73RD ST
Mailing Address - Street 2:SUITE 23
Mailing Address - City:WINDSOR HEIGHTS
Mailing Address - State:IA
Mailing Address - Zip Code:50324-1024
Mailing Address - Country:US
Mailing Address - Phone:515-284-1976
Mailing Address - Fax:515-223-3010
Practice Address - Street 1:974 73RD ST
Practice Address - Street 2:SUITE 23
Practice Address - City:WINDSOR HEIGHTS
Practice Address - State:IA
Practice Address - Zip Code:50324-1024
Practice Address - Country:US
Practice Address - Phone:515-284-1976
Practice Address - Fax:515-223-3010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA303902086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2119164Medicaid
IA38295OtherWELLMARK
IA38295OtherWELLMARK
IAD73909Medicare UPIN