Provider Demographics
NPI:1407193063
Name:HEARTLAND KIDNEY AND DIALYSIS CENTER
Entity Type:Organization
Organization Name:HEARTLAND KIDNEY AND DIALYSIS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:HAMLETT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:417-455-9255
Mailing Address - Street 1:2828 S GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:MO
Mailing Address - Zip Code:64836-7905
Mailing Address - Country:US
Mailing Address - Phone:417-358-5500
Mailing Address - Fax:417-358-5510
Practice Address - Street 1:833 N BUS 49
Practice Address - Street 2:
Practice Address - City:NEOSHO
Practice Address - State:MO
Practice Address - Zip Code:64850-6898
Practice Address - Country:US
Practice Address - Phone:417-455-9255
Practice Address - Fax:417-455-9422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-15
Last Update Date:2013-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO262657Medicare PIN