Healthcare Provider Details

I. General information

NPI: 1689361669
Provider Name (Legal Business Name): HEMICA BINTE HASAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2023
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date: 11/22/2023
Reactivation Date: 12/01/2023

III. Provider practice location address

100 MERCY WAY
JOPLIN MO
64804-4524
US

IV. Provider business mailing address

100 MERCY WAY
JOPLIN MO
64804-4524
US

V. Phone/Fax

Practice location:
  • Phone: 417-781-2727
  • Fax:
Mailing address:
  • Phone: 417-781-2727
  • Fax: 417-556-6576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2026030913
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: