Healthcare Provider Details

I. General information

NPI: 1962679936
Provider Name (Legal Business Name): CASS REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2008
Last Update Date: 02/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 E MECHANIC
HARRISONVILLE MO
64701-2017
US

IV. Provider business mailing address

1800 E MECHANIC
HARRISONVILLE MO
64701-2017
US

V. Phone/Fax

Practice location:
  • Phone: 816-380-3474
  • Fax: 816-380-4639
Mailing address:
  • Phone: 816-380-3474
  • Fax: 816-380-4639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number21942
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number21942
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code261QR0206X
TaxonomyMammography Clinic/Center
License Number21942
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code261QR0207X
TaxonomyMobile Mammography Clinic/Center
License Number21942
License Number StateMO
# 5
Primary TaxonomyY
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number21942
License Number StateMO

VIII. Authorized Official

Name: MR. JOHN CHRISTOPHER LANG
Title or Position: CEO
Credential:
Phone: 816-380-5888