Healthcare Provider Details

I. General information

NPI: 1386624518
Provider Name (Legal Business Name): HEARTLAND PATHOLOGY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 E 29TH ST N SUITE 208
WICHITA KS
67226-2182
US

IV. Provider business mailing address

PO BOX 3462
WICHITA KS
67201-3462
US

V. Phone/Fax

Practice location:
  • Phone: 316-636-5666
  • Fax: 316-652-0340
Mailing address:
  • Phone: 316-685-6236
  • Fax: 316-652-0340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number State

VIII. Authorized Official

Name: HANA RAZEK
Title or Position: PRESIDENT
Credential: MD
Phone: 316-636-5666