Healthcare Provider Details

I. General information

NPI: 1902754724
Provider Name (Legal Business Name): HEARTLAND REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2026
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 MOSAIC CT STE 102
SAINT JOSEPH MO
64506-0015
US

IV. Provider business mailing address

101 MOSAIC CT STE 102
SAINT JOSEPH MO
64506-0015
US

V. Phone/Fax

Practice location:
  • Phone: 816-205-9544
  • Fax: 816-208-4234
Mailing address:
  • Phone: 816-205-9544
  • Fax: 816-208-4234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DWIGHT CARVELL
Title or Position: DIRECTOR OF REIMBURSEMENT
Credential:
Phone: 816-273-0473