1790733608 NPI number — HEARTLAND REGIONAL MEDICAL CENTER

Table of content: DR. ROBERT GUSTAV HEROLD DDS (NPI 1437220571)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790733608 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:
HEARTLAND SUGICAL ASSOCIATES
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:
1790733608
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
901 HEARTLAND RD
Provider Second Line Business Mailing Address:
PLAZA II SUITE 1810
Provider Business Mailing Address City Name:
SAINT JOSEPH
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64506-6200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-671-4888
Provider Business Mailing Address Fax Number:
816-671-4890

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
901 HEARTLAND RD
Provider Second Line Business Practice Location Address:
PLAZA II SUITE 1810
Provider Business Practice Location Address City Name:
SAINT JOSEPH
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64506-6200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-671-4888
Provider Business Practice Location Address Fax Number:
816-671-4890
Provider Enumeration Date:
05/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MULDER
Authorized Official First Name:
GEORGE
Authorized Official Middle Name:
D
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
816-671-4888

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  MOMDR7297 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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