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NPI Code Detail

MEDICARE: HEARTLAND FAMILY PHYSICAINS CLINIC

MEDICARE: HEARTLAND FAMILY PHYSICAINS CLINIC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianMDR7D79MO

General Provider Information

NPI Number : 1205966645
Entity Type Code : Organization
Provider Name (Legal Business Name) : HEARTLAND FAMILY PHYSICAINS CLINIC
Provider Business Mailing Address
First Line : 2130 E JACKSON BLVD
Second Line :
City : JACKSON
State : MO
Zip : 63755-2907
Country : US
Telephone Number : 573-243-3115
Fax Number : 573-243-4700
Provider Business Practice Location Address
First Line : 2130 E JACKSON BLVD
Second Line :
City : JACKSON
State : MO
Zip : 63755-2907
Country : US
Telephone Number : 573-243-3115
Fax Number : 573-243-4700
Authorized Official
Title or Position : ADMINSTRATOR
Name : DR. RAMIRO ICAZA
Credential : M.D.
Telephone Number : 57352433115
Provider Enumeration Date : 03/06/2007
Last Update Date : 09/22/2010

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Directions to “HEARTLAND FAMILY PHYSICAINS CLINIC ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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