Organization
HEARTLAND DIAGNOSTIC IMAGING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EUGENE LONG MD (PRESIDENT)
(574) 533-2141
Entity
Organization
Contact information
Practice address
200 HIGH PARK AVE, GOSHEN, IN 46526-4810
(574) 533-2141
Mailing address
PO BOX 753, GOSHEN, IN 46527-0753
(937) 323-5400
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000315548
BC BS
IN
01
—
DA4142
RAILROAD MEDICARE
IN
Enumeration date
07/12/2005
Last updated
07/21/2022
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