Provider Demographics
NPI:1265528657
Name:HEARTLAND ANESTHESIA PA
Entity type:Organization
Organization Name:HEARTLAND ANESTHESIA PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:GAYLON
Authorized Official - Last Name:NEPPER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:325-641-1309
Mailing Address - Street 1:PO BOX 2368
Mailing Address - Street 2:
Mailing Address - City:BROWNWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76804-2368
Mailing Address - Country:US
Mailing Address - Phone:325-641-1309
Mailing Address - Fax:325-641-1310
Practice Address - Street 1:120 S PARK DR
Practice Address - Street 2:
Practice Address - City:BROWNWOOD
Practice Address - State:TX
Practice Address - Zip Code:76801-5918
Practice Address - Country:US
Practice Address - Phone:325-641-1309
Practice Address - Fax:325-641-1310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9240207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00367TOtherMEDICARE GROUP #
TX0051HQOtherBLUE CROSS BLUE SHIELD
TXCJ8608OtherRR MEDICARE GROUP #
TX150572901Medicaid
TX45D1086869OtherCLIA NUMBER - SA
TX45D1087227OtherCLIA NUMBER - BWD
TX00367TMedicare PIN