HERITAGE BIOLOGICS, INC.

Provider Demographics

• NPI: 1477167740
• Name: HERITAGE BIOLOGICS, INC.
• Entity Type: Organization
• Organization Name: HERITAGE BIOLOGICS, INC.
• Authorized Official - Title/Position: COMPLIANCE DIRECTOR
• Authorized Official - First Name: KATHRYN
• Authorized Official - Last Name: PEDERSON
• Authorized Official - Phone: 816-875-8269
• Mailing Address - Street 1: 255 NW VICTORIA DR
• Mailing Address - City: LEES SUMMIT
• Mailing Address - State: MO
• Mailing Address - Zip Code: 64086-4709
• Mailing Address - Country: US
• Mailing Address - Phone: 816-875-5101
• Mailing Address - Fax: 844-402-3945
• Practice Address - Street 1: 18942 HIGHWAY 13
• Practice Address - City: BRANSON WEST
• Practice Address - State: MO
• Practice Address - Zip Code: 65737
• Practice Address - Country: US
• Practice Address - Phone: 816-875-5101
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2020-09-03
• Last Update Date: 2020-09-22

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization
Yes	3336H0001X	Suppliers	Pharmacy	Home Infusion Therapy Pharmacy
No	251F00000X	Agencies	Home Infusion
No	332B00000X	Suppliers	Durable Medical Equipment & Medical Supplies
No	332BP3500X	Suppliers	Durable Medical Equipment & Medical Supplies	Parenteral & Enteral Nutrition
No	333600000X	Suppliers	Pharmacy
No	3336C0004X	Suppliers	Pharmacy	Compounding Pharmacy
No	3336S0011X	Suppliers	Pharmacy	Specialty Pharmacy

Provider Identifiers

State	Identifier ID	ID Type	Issuer
AK	1673661	Medicaid
MI	1679943229	Medicaid
IA	1679943229	Medicaid
PA	103324159	Medicaid
NH	114015	Medicaid
VA	1679943229	Medicaid
NE	10026595200	Medicaid
MD	300325600	Medicaid
ID	1679943229	Medicaid
NY	5222688	Medicaid
TN	Q051349	Medicaid
UT	3003192	Medicaid
NJ	589331	Medicaid
VT	1030474	Medicaid
MO	1679943229	Medicaid
AR	221142407	Medicaid
AR	229561716	Medicaid
AZ	268956	Medicaid
IN	300002797	Medicaid
IL	1679943229	Medicaid
MN	1679943229	Medicaid
OK	200661640	Medicaid
KS	201124950A	Medicaid
LA	2205595	Medicaid
OH	229129	Medicaid
SC	7M3667	Medicaid