1881859627 NPI number — HEARTLAND REGIONAL MEDICAL CENTER

Table of content: (NPI 1881859627)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881859627 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:
MOSAIC LIFE CARE AT ST JOSEPH
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:
1881859627
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/10/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5325 FARAON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT JOSEPH
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64506-3488
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-271-6000
Provider Business Mailing Address Fax Number:
816-271-7678

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
802 N RIVERSIDE RD
Provider Second Line Business Practice Location Address:
STE 150
Provider Business Practice Location Address City Name:
SAINT JOSEPH
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64507-2502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-271-4025
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/22/2008

Additional Information

Authorized Official

Authorized Official Last Name:
PATTERSON
Authorized Official First Name:
CINDY
Authorized Official Middle Name:
G
Authorized Official Title or Position:
PROVIDER ENROLLMENT SPECIALIST
Authorized Official Telephone Number:
816-271-7861

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , 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)

  • Identifier: 508279908 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100099580 , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".




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