1679943229 NPI number — HERITAGE BIOLOGICS, LLC

Table of content: (NPI 1679943229)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679943229 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:
HERITAGE BIOLOGICS, INC.
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:
1679943229
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/05/2024
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:
816-875-5101
Provider Business Mailing Address Fax Number:
844-402-3945

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
255 NW VICTORIA DR STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEES SUMMIT
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64086-4709
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:
844-402-3945
Provider Enumeration Date:
09/25/2015

Additional Information

Authorized Official

Authorized Official Last Name:
WALLPE
Authorized Official First Name:
MEREDITH
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF REVENUE CYCLE
Authorized Official Telephone Number:
816-875-5204

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: 3336C0004X ; 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" .
  • Taxonomy code: 3336S0011X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1673661 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1679943229 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1679943229 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1679943229 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7M3667 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1679943229 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2205595 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 103324159 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 167943229 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1679943229 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1030474 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1679943229 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1679943229 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 600026061 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0229129 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200661640A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2081347 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2154209 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0589331 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 114015 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".




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