Healthcare Provider Details

I. General information

NPI: 1336491695
Provider Name (Legal Business Name): HEARTLAND REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2012
Last Update Date: 09/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6301 N LUCERNE AVE
KANSAS CITY MO
64151-3105
US

IV. Provider business mailing address

5325 FARAON ST
SAINT JOSEPH MO
64506-3488
US

V. Phone/Fax

Practice location:
  • Phone: 816-569-1802
  • Fax:
Mailing address:
  • Phone: 816-271-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number246-0
License Number StateMO

VIII. Authorized Official

Name: JOHN WILSON
Title or Position: CFO
Credential:
Phone: 816-271-6611