Basic Information
| Provider Information | |||||||||
| NPI: | 1811034887 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HEARTLAND RADIOLOGY, PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9313 E 34TH ST N | ||||||||
| Address2: | STE 100 | ||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672262637 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3166856091 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1124 W 21ST | ||||||||
| Address2: | |||||||||
| City: | ANDOVER | ||||||||
| State: | KS | ||||||||
| PostalCode: | 67002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3163004000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/31/2007 | ||||||||
| LastUpdateDate: | 06/16/2008 | ||||||||
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| AuthorizedOfficialLastName: | TOUMEH | ||||||||
| AuthorizedOfficialFirstName: | KHALED | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3166856091 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0204X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology |
ID Information
| ID | Type | State | Issuer | Description | 111299 | 01 | KS | BCBS | OTHER |