Basic Information
| Provider Information | |||||||||
| NPI: | 1811044019 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HEARTLAND INTERNAL MEDICINE SERVICES LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 388 | ||||||||
| Address2: | |||||||||
| City: | NEWTON | ||||||||
| State: | KS | ||||||||
| PostalCode: | 671140388 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3162813700 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1151 N ROCK RD | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672061262 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3166343400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/03/2007 | ||||||||
| LastUpdateDate: | 05/18/2011 | ||||||||
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| AuthorizedOfficialLastName: | RAFFI | ||||||||
| AuthorizedOfficialFirstName: | SYED | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3163931541 | ||||||||
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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 | 208M00000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.