Provider Demographics
NPI:1447280474
Name:HEARTLAND PATHOLOGY CONSULTANTS, PC
Entity type:Organization
Organization Name:HEARTLAND PATHOLOGY CONSULTANTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:ROSIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:CHEADLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-705-2644
Mailing Address - Street 1:PO BOX 26343
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73126-0343
Mailing Address - Country:US
Mailing Address - Phone:405-705-0018
Mailing Address - Fax:405-705-0029
Practice Address - Street 1:2701 COLTRANE PL STE 3
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-6783
Practice Address - Country:US
Practice Address - Phone:405-715-4500
Practice Address - Fax:405-715-4519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic PathologyGroup - Multi-Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100746640AMedicaid
OK100746640AMedicaid
OK=========004OtherTRICARE
OK100746640AMedicaid