Provider Demographics
NPI:1568443711
Name:CASS REGIONAL MEDICAL CENTER
Entity Type:Organization
Organization Name:CASS REGIONAL MEDICAL CENTER
Other - Org Name:HARRISONVILLE MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:LANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-358-8888
Mailing Address - Street 1:2820 E ROCK HAVEN ROAD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:HARRISONVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64701-4414
Mailing Address - Country:US
Mailing Address - Phone:816-380-7470
Mailing Address - Fax:816-380-3291
Practice Address - Street 1:2820 E ROCK HAVEN ROAD
Practice Address - Street 2:SUITE 210
Practice Address - City:HARRISONVILLE
Practice Address - State:MO
Practice Address - Zip Code:64701-4414
Practice Address - Country:US
Practice Address - Phone:816-380-7470
Practice Address - Fax:816-380-3291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-07
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
26786014OtherBCBS
MO599764206Medicaid
7060000OtherMEDICARE
MO599764206Medicaid