1538135207 NPI number — HEARTLAND DERMATOLOGY AND SKIN CANCER CENTER, PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538135207 NPI number — HEARTLAND DERMATOLOGY AND SKIN CANCER CENTER, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEARTLAND DERMATOLOGY AND SKIN CANCER CENTER, PA
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:
HEARTLAND DERMATOLOGY CENTER, PA
Provider Other Organization Name Type Code:
4
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:
1538135207
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/29/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
828 ELMHURST BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALINA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67401-7406
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
785-827-2500
Provider Business Mailing Address Fax Number:
785-827-2515

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
828 ELMHURST BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALINA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67401-7406
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-827-2500
Provider Business Practice Location Address Fax Number:
785-827-2515
Provider Enumeration Date:
02/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SHAFFER
Authorized Official First Name:
MATTHEW
Authorized Official Middle Name:
P
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
785-577-4448

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 110061 . This is a "BCBS (GREAT BEND LOCATION" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 110942 . This is a "BCBS (SALINA LOCATION)" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 623450 . This is a "FIRST GUARD" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 110060 . This is a "BCBS (HAYS LOCATION)" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: C54705 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




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