Provider Demographics
NPI:1366434854
Name:HEARTLAND CARDIOLOGY PC
Entity type:Organization
Organization Name:HEARTLAND CARDIOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:D
Authorized Official - Last Name:MCLEAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-991-5300
Mailing Address - Street 1:8552 CASS ST
Mailing Address - Street 2:#308
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-3570
Mailing Address - Country:US
Mailing Address - Phone:402-991-5300
Mailing Address - Fax:402-991-5407
Practice Address - Street 1:8552 CASS ST
Practice Address - Street 2:#308
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-3570
Practice Address - Country:US
Practice Address - Phone:402-991-5300
Practice Address - Fax:402-991-5407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-19
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA30071207RC0000X
NE18014207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0544817Medicaid
IA59814OtherBC
NE31944OtherBC
110145179OtherRRMC
2500216OtherUHC
NE=========13Medicaid
IA59814OtherBC
2500216OtherUHC
IAI5156Medicare PIN