1538159058 NPI number — CASS REGIONAL MEDICAL CENTER

Table of content: JESSIANN ANDRUS PA (NPI 1417382789)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538159058 NPI number — CASS REGIONAL MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CASS 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:
PLEASANT HILL MEDICAL CENTER
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:
1538159058
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/01/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2800 E ROCK HAVEN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARRISONVILLE
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64701-4411
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-887-0315
Provider Business Mailing Address Fax Number:
816-380-0718

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1601 N HIGHWAY 7
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLEASANT HILL
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64080-1945
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-540-2111
Provider Business Practice Location Address Fax Number:
816-540-6065
Provider Enumeration Date:
10/26/2005

Additional Information

Authorized Official

Authorized Official Last Name:
ELLIOTT
Authorized Official First Name:
JANIE
Authorized Official Middle Name:
Authorized Official Title or Position:
BUSINESS OFFICE MANAGER
Authorized Official Telephone Number:
816-887-0315

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 598296101 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 22290019 . This is a "BCBS GRP NUMBER" identifier . This identifiers is of the category "OTHER".




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