Provider Demographics
NPI: | 1477575405 |
---|---|
Name: | HEARTLAND REGIONAL MEDICAL CENTER |
Entity Type: | Organization |
Organization Name: | HEARTLAND REGIONAL MEDICAL CENTER |
Other - Org Name: | MOSAIC LIFE CARE |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | PROVIDER ENROLLMENT SPECIALIST |
Authorized Official - Prefix: | |
Authorized Official - First Name: | CINDY |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | PATTERSON |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 816-271-7861 |
Mailing Address - Street 1: | 5325 FARAON ST |
Mailing Address - Street 2: | |
Mailing Address - City: | SAINT JOSEPH |
Mailing Address - State: | MO |
Mailing Address - Zip Code: | 64506-3488 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 816-271-6000 |
Mailing Address - Fax: | 816-271-6786 |
Practice Address - Street 1: | 5325 FARAON ST |
Practice Address - Street 2: | |
Practice Address - City: | SAINT JOSEPH |
Practice Address - State: | MO |
Practice Address - Zip Code: | 64506-3488 |
Practice Address - Country: | US |
Practice Address - Phone: | 816-271-6000 |
Practice Address - Fax: | 816-271-7678 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-07-25 |
Last Update Date: | 2016-03-14 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
207LA0401X | ||
MO | 426-19 | 207LP2900X, 207P00000X, 207Q00000X, 207R00000X, 207RC0000X, 207T00000X, 207V00000X, 207Y00000X, 208100000X, 208200000X, 2084N0400X, 208D00000X, 208M00000X, 208VP0000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 208D00000X | Allopathic & Osteopathic Physicians | General Practice | Group - Multi-Specialty | |
No | 207LA0401X | Allopathic & Osteopathic Physicians | Anesthesiology | Addiction Medicine | Group - Multi-Specialty |
No | 207LP2900X | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | Group - Multi-Specialty |
No | 207P00000X | Allopathic & Osteopathic Physicians | Emergency Medicine | Group - Multi-Specialty | |
No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
No | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Multi-Specialty |
No | 207T00000X | Allopathic & Osteopathic Physicians | Neurological Surgery | Group - Multi-Specialty | |
No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
No | 207Y00000X | Allopathic & Osteopathic Physicians | Otolaryngology | Group - Multi-Specialty | |
No | 208100000X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Group - Multi-Specialty | |
No | 208200000X | Allopathic & Osteopathic Physicians | Plastic Surgery | Group - Multi-Specialty | |
No | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | Group - Multi-Specialty |
No | 208M00000X | Allopathic & Osteopathic Physicians | Hospitalist | Group - Multi-Specialty | |
No | 208VP0000X | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
MO | 540156809 | Medicaid | |
MO | 260006 | Medicare PIN | |
MO | 540156809 | Medicaid |