1679173520 NPI number — HERITAGE BIOLOGICS, LLC

Table of content: (NPI 1679173520)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679173520 NPI number — HERITAGE BIOLOGICS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HERITAGE BIOLOGICS, LLC
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:
1679173520
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/21/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
255 NW VICTORIA DR, STE B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEES SUMMIT
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64086-4709
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
855-937-7273
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6313 PRESTON RD STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLANO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75024-2684
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
855-937-7273
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/29/2020

Additional Information

Authorized Official

Authorized Official Last Name:
KALEIKAU
Authorized Official First Name:
BRIANNA
Authorized Official Middle Name:
Authorized Official Title or Position:
SR. DIRECTOR OF QUALITY
Authorized Official Telephone Number:
816-875-5256

Provider Taxonomy Codes

  • Taxonomy code: 251F00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BP3500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336H0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 33954 . This is a "STATE PERMIT" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 10324159 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200661640C , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 297829407 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1679173520 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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