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NPI Code Detail

MEDICARE: HEARTLAND WEIGHT LOSS CLINIC, LLC

MEDICARE: HEARTLAND WEIGHT LOSS CLINIC, LLC
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
1261QM2500XMedical Specialty Clinic/Center

General Provider Information

NPI Number : 1215536818
Entity Type Code : Organization
Provider Name (Legal Business Name) : HEARTLAND WEIGHT LOSS CLINIC, LLC
Provider Business Mailing Address
First Line : 3095 LEXINGTON AVE STE 200
Second Line :
City : CAPE GIRARDEAU
State : MO
Zip : 63701-2629
Country : US
Telephone Number : 573-803-2287
Fax Number :
Provider Business Practice Location Address
First Line : 3095 LEXINGTON AVE STE 200
Second Line :
City : CAPE GIRARDEAU
State : MO
Zip : 63701-2629
Country : US
Telephone Number : 573-803-2287
Fax Number :
Authorized Official
Title or Position : PHYSICIAN
Name : RYAN A LEGRAND
Credential : MD
Telephone Number : 573-803-2287
Provider Enumeration Date : 10/23/2020
Last Update Date : 04/06/2023

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Directions to “HEARTLAND WEIGHT LOSS CLINIC, LLC ” Practice Location

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