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

Table of content: (NPI 1538135207)

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:
Provider Other Organization Name Type Code:
6
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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