Basic Information
| Provider Information | |||||||||
| NPI: | 1952372286 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HEARTLAND RADIOLOGY ASSOCIATES LTD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4227 LINCOLNSHIRE DR | ||||||||
| Address2: | |||||||||
| City: | MOUNT VERNON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 628642157 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6182422317 | ||||||||
| FaxNumber: | 6182429710 | ||||||||
| Practice Location | |||||||||
| Address1: | 502 W ST LOUIS ST | ||||||||
| Address2: | |||||||||
| City: | WEST FRANKFORT | ||||||||
| State: | IL | ||||||||
| PostalCode: | 628961957 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6189374895 | ||||||||
| FaxNumber: | 6189374916 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/26/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | TRESCHUK-BAHN | ||||||||
| AuthorizedOfficialFirstName: | JACQUELINE | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6182422317 | ||||||||
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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 | 2085R0202X | 9256833 | IL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.