Healthcare Provider Details

I. General information

NPI: 1891715652
Provider Name (Legal Business Name): HARRISONVILLE FAMILY MEDICINE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 01/13/2026
Certification Date: 01/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2820 E ROCK HAVEN RD SUITE 100
HARRISONVILLE MO
64701-4411
US

IV. Provider business mailing address

2820 E ROCK HAVEN RD SUITE 100
HARRISONVILLE MO
64701-4411
US

V. Phone/Fax

Practice location:
  • Phone: 816-380-3582
  • Fax: 816-380-6964
Mailing address:
  • Phone: 816-380-3582
  • Fax: 816-380-6964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number StateMO

VIII. Authorized Official

Name: SHAUN HOLDEN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 816-380-3582