1457375859 NPI number — HEARTLAND REGIONAL MEDICAL CENTER

Table of content: (NPI 1457375859)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457375859 NPI number — HEARTLAND REGIONAL MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEARTLAND REGIONAL MEDICAL CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
COUNSELING CARE MOSAIC LIFE CARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457375859
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/25/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
137 N BELT HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT JOSEPH
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64506-3491
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-271-6573
Provider Business Mailing Address Fax Number:
816-271-6572

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3620 FREDERICK AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT JOSEPH
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64506-3016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-271-6573
Provider Business Practice Location Address Fax Number:
816-271-6572
Provider Enumeration Date:
07/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CARVELL
Authorized Official First Name:
DWIGHT
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR, REIMBURSEMENT - ACCOUNTIN
Authorized Official Telephone Number:
816-273-0473

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  00996 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103T00000X , with the licence number: 00711 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 104100000X , with the licence number: SW001949 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 104100000X , with the licence number: SW000121 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 18524038 . This is a "BLUE CROSS/ BLUE SHIELD" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 10001309000 . This is a "COMMUNITY HEALTH PLAN" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 215265836 . This is a "UBH" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 241020 . This is a "VALUE OPTIONS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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