Basic Information
| Provider Information | |||||||||
| NPI: | 1447280474 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HEARTLAND PATHOLOGY CONSULTANTS, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 26343 | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731260343 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4057050018 | ||||||||
| FaxNumber: | 4057050029 | ||||||||
| Practice Location | |||||||||
| Address1: | 2701 COLTRANE PL STE 3 | ||||||||
| Address2: | |||||||||
| City: | EDMOND | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730346783 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4057154500 | ||||||||
| FaxNumber: | 4057154519 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/04/2006 | ||||||||
| LastUpdateDate: | 12/08/2021 | ||||||||
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| AuthorizedOfficialLastName: | CHEADLE | ||||||||
| AuthorizedOfficialFirstName: | ROSIE | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | BILLING SUPERVISOR | ||||||||
| AuthorizedOfficialTelephone: | 4057052644 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 12/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | N | Laboratories | Clinical Medical Laboratory | 207ZP0101X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology |
ID Information
| ID | Type | State | Issuer | Description | 100746640A | 05 | OK | MEDICAID |