Provider Demographics
NPI:1538135207
Name:HEARTLAND DERMATOLOGY AND SKIN CANCER CENTER, PA
Entity Type:Organization
Organization Name:HEARTLAND DERMATOLOGY AND SKIN CANCER CENTER, PA
Other - Org Name:HEARTLAND DERMATOLOGY CENTER, PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:P
Authorized Official - Last Name:SHAFFER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:785-577-4448
Mailing Address - Street 1:828 ELMHURST BLVD
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-7406
Mailing Address - Country:US
Mailing Address - Phone:785-827-2500
Mailing Address - Fax:785-827-2515
Practice Address - Street 1:828 ELMHURST BLVD
Practice Address - Street 2:
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-7406
Practice Address - Country:US
Practice Address - Phone:785-827-2500
Practice Address - Fax:785-827-2515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-23
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS110061OtherBCBS (GREAT BEND LOCATION
KS110942OtherBCBS (SALINA LOCATION)
KS623450OtherFIRST GUARD
KS110060OtherBCBS (HAYS LOCATION)
KSC54705OtherRAILROAD MEDICARE
KS623450OtherFIRST GUARD
KS110060OtherBCBS (HAYS LOCATION)
KSC54705OtherRAILROAD MEDICARE