MEDICARE: HEARTLAND 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
1	282N00000X	General Acute Care Hospital	100462	MO

General Provider Information

NPI Number	:	1417905142
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEARTLAND CLINIC

Provider Business Mailing Address
First Line	:	901 HEARTLAND ROAD
Second Line	:	PLAZA II SUITE 1810
City	:	ST. JOSEPH
State	:	MO
Zip	:	64506-6201
Country	:	US
Telephone Number	:	816-671-4888
Fax Number	:	816-671-4890

Provider Business Practice Location Address
First Line	:	901 HEARTLAND ROAD
Second Line	:	PLAZA II SUITE 1810
City	:	ST. JOSEPH
State	:	MO
Zip	:	64506-6201
Country	:	US
Telephone Number	:	816-671-4888
Fax Number	:	816-671-4890

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	SCOTT A WADE
Credential	:	M.D.
Telephone Number	:	816-671-4888

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	08/22/2020

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Directions to “HEARTLAND CLINIC ” Practice Location

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