=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538135207
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEARTLAND DERMATOLOGY AND SKIN CANCER CENTER, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/23/2006
-----------------------------------------------------
Last Update Date | 10/21/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 828 ELMHURST BLVD
-----------------------------------------------------
City | SALINA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67401-7406
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 785-827-2500
-----------------------------------------------------
Fax | 785-827-2515
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9300 E 29TH ST N STE 310
-----------------------------------------------------
City | WICHITA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67226-2160
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-612-1833
-----------------------------------------------------
Fax | 316-612-2420
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. MATTHEW P SHAFFER
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 785-577-4448
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207N00000X
-----------------------------------------------------
Taxonomy Name | Dermatology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------