Provider Demographics
NPI:1255776415
Name:HEARTLAND O&P INC.
Entity type:Organization
Organization Name:HEARTLAND O&P INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:BLAINE
Authorized Official - Last Name:PITTS
Authorized Official - Suffix:
Authorized Official - Credentials:CPO 2980
Authorized Official - Phone:620-402-6789
Mailing Address - Street 1:PO BOX 1163
Mailing Address - Street 2:
Mailing Address - City:ARKANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67005-1163
Mailing Address - Country:US
Mailing Address - Phone:620-402-6789
Mailing Address - Fax:
Practice Address - Street 1:22215 TUPPER STREET
Practice Address - Street 2:SUITE B
Practice Address - City:WINFIELD
Practice Address - State:KS
Practice Address - Zip Code:67156
Practice Address - Country:US
Practice Address - Phone:620-402-6789
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-01
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSC.P.O. 2980332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSC.P.O.2980OtherAMERICAN BOARD OF CERTIFICATION FOR ORTHOTICS AND PROSTHETICS
KSC.P.O.2980OtherAMERICAN BOARD OF CERTIFICATION FOR ORTHOTICS AND PROSTHETICS