Provider Demographics
NPI:1619978061
Name:HEARTLAND HEALTH LABORATORIES, LLC
Entity type:Organization
Organization Name:HEARTLAND HEALTH LABORATORIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BUSINESS OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:BLAKE
Authorized Official - Middle Name:
Authorized Official - Last Name:WERNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-549-8355
Mailing Address - Street 1:16840 BUCCANEER LN STE 261
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-2570
Mailing Address - Country:US
Mailing Address - Phone:832-932-5968
Mailing Address - Fax:
Practice Address - Street 1:10435 LACKMAN RD
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66219-1221
Practice Address - Country:US
Practice Address - Phone:832-932-5968
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17D1027382291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS9004241Medicare ID - Type Unspecified