Provider Demographics
NPI:1447672571
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/CPO
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 1:1901 MEADOWBROOK ST
Mailing Address - Street 2:
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74604-3012
Mailing Address - Country:US
Mailing Address - Phone:580-352-2378
Mailing Address - Fax:
Practice Address - Street 1:919 WESTPORT PL
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-2913
Practice Address - Country:US
Practice Address - Phone:785-320-2320
Practice Address - Fax:785-320-2321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-08
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment